Subpial schwannoma of the cervical spinal cord mimicking an intramedullary tumor

Object Alteration of cerebrospinal fluid (CSF) flow has been proposed as an important mechanism leading to the development of syringomyelia. We hypothesize that a “presyrinx” condition due to potentially reversible alteration in normal CSF flow exists and that its appearance may be due to variations in the competence of the central canal of the spinal cord. Methods Five patients with clinical evidence of myelopathy, no history of spinal cord trauma, enlargement of the cervical spinal cord with T1 and T2 prolongation but no cavitation, evidence for altered or obstructed CSF flow, and no evidence of intramedullary tumor or a spinal vascular event underwent MR imaging before and after intervention that alleviated obstruction to CSF flow. Results Preoperatively, all patients demonstrated enlarged spinal cords and parenchymal T1 and T2 prolongation without cavitation. Results of magnetic resonance (MR) imaging examinations following intervention in all patients showed resolution of cord enlargement and normalization or improvement of cord signal abnormalities. In one patient with severe arachnoid adhesions who initially improved following decompression, late evolution into syringomyelia occurred in association with continued CSF obstruction. Conclusion Nontraumatic obstruction of the CSF pathways in the spine may result in spinal cord parenchymal T2 prolongation that is reversible following restoration of patency of CSF pathways. We refer to this MR appearance as the “presyrinx” state and stress the importance of timely intervention to limit progression to syringomyelia.

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Inflammatory Myelopathy Presenting as a Cystic Intramedullary Spinal Cord Lesion

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100045807 ◽

1984 ◽

Vol 11 (3) ◽

pp. 399-401

Author(s):

B.I. Tranmer ◽

T.A. Gray ◽

W.J. Horsey ◽

C.G. Gonsalves

Keyword(s):

Spinal Cord ◽

Cervical Spinal Cord ◽

Correct Diagnosis ◽

Careful Analysis ◽

Intramedullary Tumor ◽

Cervical Cord ◽

Intramedullary Spinal Cord ◽

Cystic Tumour ◽

Computed Tomographic ◽

Inflammatory Changes

ABSTRACT:A case of subacute progressive spinal tetraparesis had myelographic evidence of cervical spinal cord swelling and a delayed metrizamide computed tomographic myelogram (MCTM) suggested cavitation within the swollen spinal cord. Surgical exploration of the cervical cord revealed inflammatory changes only. No syrinx or intramedullary tumour was found. The accumulation of metrizamide within the spinal cord, as demonstrated by MCTM, did not’respresent a syrinx or a cystic tumour, but more likely an area of inflammation. Because inflammatory myelopathy may simulate an intramedullary tumor or syrinx, careful analysis of all clinical and radiological information is necessary to help make a correct diagnosis.

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Facial pain as an initial manifestation of intramedullary cervical spinal cord tumor: A case report and literature review

Surgical Neurology International ◽

10.25259/sni_546_2019 ◽

2020 ◽

Vol 11 ◽

pp. 173

Author(s):

Vidzhai Dzhafarov ◽

Jamil Rzaev ◽

Galina Moysak ◽

Eugenia Voronina

Keyword(s):

Spinal Cord ◽

Trigeminal Neuralgia ◽

Facial Pain ◽

Cervical Spinal Cord ◽

Spinal Cord Tumor ◽

Clinical Feature ◽

Intramedullary Tumor ◽

Subtotal Resection ◽

Neurovascular Conflict ◽

Initial Manifestation

Background: Facial pain resembling trigeminal neuralgia is not a common clinical feature of cervical spinal cord tumor. Depending on nature of the facial pain, differential diagnosis tends to include neurovascular conflict, multiple sclerosis, cerebellopontine angle tumors, herpes zoster, facial injuries, and other conditions involving trigeminal nerve, ganglion, and root. Here, we present a unique case of pain in trigeminal distribution due to an intramedullary tumor in the upper cervical spinal cord. Case Description: A 27-year-old male was admitted with complaints of intense facial pain on the right side lasting for several years. MRI revealed an intramedullary lesion at the C1 level and no signs of a neurovascular conflict or a demyelination. This lesion was removed microsurgically, with the subtotal resection immediately abolishing the pain and causing no additional neurological deficit. Histological analysis revealed ganglioglioma, Grade 1. After 5-day hospital stay, the patient was discharged home; 2-year follow-up showed no tumor recurrence on MRI and persistent relief of facial pain. Conclusion: Secondary trigeminal neuralgia may be explained by a pathological process in vicinity of the spinal trigeminal nuclei. Removing the tumor may be expected to provide complete and lasting pain relief.

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Clinical application of a chest respirator to a patient with dyspnea after extirpation of an intramedullary tumor of the cervical spinal cord.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.32.105 ◽

1984 ◽

Vol 32 (1) ◽

pp. 105-107

Author(s):

H. Isioka ◽

T. Ikata ◽

K. Takata ◽

T. Sasaki ◽

T. Endo ◽

...

Keyword(s):

Spinal Cord ◽

Clinical Application ◽

Cervical Spinal Cord ◽

Intramedullary Tumor

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Intramedullary Clear Cell Ependymoma in the Cervical Spinal Cord: Case Report

Neurosurgery ◽

10.1097/00006123-200012000-00034 ◽

2000 ◽

Vol 47 (6) ◽

pp. 1434-1434 ◽

Cited By ~ 16

Author(s):

Hiroyoshi Akutsu ◽

Yasushi Shibata ◽

Masao Okazaki ◽

Akio Hyodo ◽

Akira Matsumura

Keyword(s):

Spinal Cord ◽

Case Report ◽

Histological Analysis ◽

Clinical Presentation ◽

Clear Cell ◽

Cervical Spinal Cord ◽

Intramedullary Tumor ◽

Intramedullary Spinal Cord ◽

First Case ◽

Clear Cell Ependymoma

ABSTRACT OBJECTIVE AND IMPORTANCE Clear cell ependymoma of the spinal cord has not been reported in the literature, although ependymoma in the cerebral and cerebellar hemispheres has been described. We present the first case report of this rare histological type of ependymoma arising in the cervical spinal cord and emphasize the importance of recognizing this histological entity. CLINICAL PRESENTATION A 42-year-old woman presented with numbness in both upper limbs and spastic gait. Magnetic resonance imaging revealed an intramedullary tumor at the C6–T1 level with syringomyelia. INTERVENTION The tumor was totally removed. Histological analysis revealed that the tumor was composed of round cells with perinuclear halos similar to those observed in oligodendroglioma. However, we diagnosed clear cell ependymoma because these tumor cells exhibited epithelial features and ependymal rosettes under light microscopic examination. CONCLUSION Histological diagnosis was crucial to our determining whether to perform postoperative adjuvant therapy in this patient. Neurosurgeons should be aware of the possibility of this histological entity among intramedullary spinal cord tumors.

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Intramedullary spinal cord metastases from small cell carcinoma of the lung.

Journal of Clinical Oncology ◽

10.1200/jco.1983.1.2.99 ◽

1983 ◽

Vol 1 (2) ◽

pp. 99-106 ◽

Cited By ~ 34

Author(s):

K C Murphy ◽

R Feld ◽

W K Evans ◽

F A Shepherd ◽

R Perrin ◽

...

Keyword(s):

Spinal Cord ◽

Cell Carcinoma ◽

Small Cell Carcinoma ◽

Radiation Treatment ◽

Cervical Spinal Cord ◽

Small Cell ◽

Intramedullary Tumor ◽

Combined Modality Treatment ◽

Intramedullary Spinal Cord ◽

Brown Sequard Syndrome

Four patients with intramedullary spinal cord metastases from small cell carcinoma of the lung (SCCL) are described, with emphasis on clinical presentation and treatment. All patients developed the Brown-Séquard syndrome due to intramedullary tumor in the cervical spinal cord, three within 2 mo after combined modality treatment using chemotherapy and radiotherapy. One patient presented with a Brown-Séquard syndrome and an extradural spinal cord compression from tumor. The radiological and cerebrospinal fluid findings are presented and discussed. Radiation treatment was administered to the involved segments of spinal cord in each patient. All patients responded; two for 3 and 7 mo, two for 3 and 4 wk, respectively. There was significant improvement in the quality of life for three of the four patients.

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Alterations in the number of motoneurons containing immunoreactive calcitonin gene-related peptide(CGRP)& choline acetyltransferase(ChAT) in the cervical spinal cord of the wobbler mouse during the development of the motoneuron disease

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100141226 ◽

1995 ◽

Vol 53 ◽

pp. 970-971

Author(s):

L. Vacca-Galloway ◽

Y.Q. Zhang ◽

P. Bose ◽

S.H. Zhang

Keyword(s):

Spinal Cord ◽

Early Stage ◽

Cervical Spinal Cord ◽

Wild Type Mouse ◽

Reflex Response ◽

Mouse Strains ◽

Behavioral Tests ◽

Wobbler Mouse ◽

Stage 4 ◽

Stage 1

The Wobbler mouse (wr) has been studied as a model for inherited human motoneuron diseases (MNDs). Using behavioral tests for forelimb power, walking, climbing, and the “clasp-like reflex” response, the progress of the MND can be categorized into early (Stage 1, age 21 days) and late (Stage 4, age 3 months) stages. Age-and sex-matched normal phenotype littermates (NFR/wr) were used as controls (Stage 0), as well as mice from two related wild-type mouse strains: NFR/N and a C57BI/6N. Using behavioral tests, we also detected pre-symptomatic Wobblers at postnatal ages 7 and 14 days. The mice were anesthetized and perfusion-fixed for immunocytochemical (ICC) of CGRP and ChAT in the spinal cord (C3 to C5).Using computerized morphomety (Vidas, Zeiss), the numbers of IR-CGRP labelled motoneurons were significantly lower in 14 day old Wobbler specimens compared with the controls (Fig. 1). The same trend was observed at 21 days (Stage 1) and 3 months (Stage 4). The IR-CGRP-containing motoneurons in the Wobbler specimens declined progressively with age.

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