Intramedullary spinal cavernous malformations (ISCMs) are rare vascular lesions of the spinal cord. Those located in the conus medullaris are exceptionally uncommon, and our understanding of them is primarily based on individual case reports. We report a case of a 60-year-old patient with a history of multiple cerebral cavernous malformations who presented with rapidly progressive paraplegia. Magnetic resonance imaging (MRI) revealed an intramedullary hemorrhage from a cavernous malformation in the conus medullaris. Despite initial conservative management, the patient’s neurological symptoms progressed. A Th11-12 laminectomy and total excision of the cavernous malformation were performed.
The postoperative period was uneventful. Despite treatment, there was no improvement in the patient’s neurological condition at a 15-month follow-up. This case highlights the significant diagnostic and therapeutic challenges associated with ISCMs of the conus medullaris.