Spinal cord tumor versus transverse myelitis

The differential diagnoses for spinal cord lesions include spinal tumors and inflammatory processes. The distinction between these pathologies can be difficult if solely based on imaging. We report for the first time to our knowledge a case of idiopathic transverse myelitis (ITM) mimicking a discrete cervical spinal lesion in a 66-year-old man who presented with gait instability and neck pain. The patient’s symptoms failed to resolve after an initial course of steroid therapy. Surgical biopsy confirmed the diagnosis of ITM. Subsequent treatment with dexamethasone resulted in complete resolution of the symptoms as well as the intramedullary enhancement. ITM is most common in the cervical and thoracic spine, spanning 3-4 spinal segments. It usually occupies more than 50% of the cross-sectional area of the spinal cord and tends to be central, uniform, and symmetric. It exhibits patchy and peripheral contrast enhancement. These criteria are useful guidelines that help distinguish ITM from neoplastic spinal lesions. A decision to perform biopsy must take into consideration the patient’s clinical symptoms, the rate of progression of neurological deficits, and the imaging characteristics of the lesion. Surgical biopsy for questionable lesions should be reserved for patients with progressive neurological deficits refractory to empirical medical therapy.

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Etiological Diagnosis of Non-Traumatic Myelopathies: Experience in a Tertiary Health Care Center in Bangladesh

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v36i2.36066 ◽

2018 ◽

Vol 36 (2) ◽

pp. 53-58

Author(s):

Narayan Chandra Kundu ◽

Firoz Ahmed Quraishi ◽

Moushumi Sen

Keyword(s):

Spinal Cord ◽

Spinal Cord Tumor ◽

Transverse Myelitis ◽

P Value ◽

Disc Disease ◽

Duration Of Symptoms ◽

Etiological Diagnosis ◽

Pott’S Disease ◽

Number Of Patients ◽

Vertebral Disc

Background: The relative frequency of non-traumatic compressive and non-compressive myelopathies and their etiologies have not been evaluated extensively in Bangladesh. This study was aimed to identify the etiological diagnosis of non-traumatic myelopathies.Methods: One hundred cases of non-traumatic myelopathic admitted patients were prospectively studied during 2009- 2012 in the neurology ward of Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh. Patients underwent a detailed clinical evaluation followed by laboratory investigations and neuroimaging studies.Results: Among 100 cases, 46 patients (male 41 and female 5) presented with quadriparesis and 54 patients (male 30 and female 24) presented with paraparesis. Duration of symptoms before presentation to the hospital was considerably higher in quadriparesis compared to paraparesis (230.09 ± 31.16 days VS 136.82 ± 21.77 days; p value = 0.016). There were no significant differences in the number of patients admitted between compressive and non-compressive groups (p value – 0.4035). Common etiologies observed in this study were vertebral disc disease (23%), spinal cord tumor (15%), Pott’s disease (15%), acute transverse myelitis (13%) and motor neuron disease (11%).Conclusion: Vertebral disc disease, spinal cord tumors, infection (Pott’s disease), post infectious condition (ATM), and neurodegenerative disease (MND) are mostly responsible for myelopathies.J Bangladesh Coll Phys Surg 2018; 36(2): 53-58

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Microsurgical resection of intramedullary spinal cord ependymoma

Neurosurgical FOCUS ◽

10.3171/2014.v3.focus14276 ◽

2014 ◽

Vol 37 (v2supplement) ◽

pp. Video9

Author(s):

Paul C. McCormick

Keyword(s):

Spinal Cord ◽

Growth Rate ◽

Spinal Cord Tumor ◽

Intramedullary Spinal Cord ◽

Clear Margin ◽

Intramedullary Spinal Cord Tumor ◽

Link Type ◽

Microsurgical Resection ◽

Spinal Cord Ependymoma ◽

Posterior Midline

Ependymomas are the most commonly occurring intramedullary spinal cord tumor in adults. With few exceptions these tumors are histologically benign, although they exhibit some biologic variability with respect to growth rate. While unencapsulated, spinal ependymomas are non-infiltrative and present a clear margin of demarcation from the surrounding spinal cord that serves as an effective dissection plane. This video demonstrates the technique of microsurgical resection of an intramedullary ependymoma through a posterior midline myelotomy.The video can be found here: http://youtu.be/lcHhymSvSqU.

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Autonomic dysreflexia associated with cervical spinal cord gliofibroma: case report

BMC Neurology ◽

10.1186/s12883-021-02271-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hiroyuki Mizuno ◽

Fumiaki Honda ◽

Hayato Ikota ◽

Yuhei Yoshimoto

Keyword(s):

Spinal Cord ◽

Cervical Spinal Cord ◽

Spinal Cord Tumor ◽

Autonomic Dysreflexia ◽

Tumor Biopsy ◽

Intramedullary Lesion ◽

First Case ◽

Cord Injury ◽

Paroxysmal Hypertension ◽

Upper And Lower Extremities

Abstract Background Autonomic dysreflexia (AD) is an abnormal reflex of the autonomic nervous system normally observed in patients with spinal cord injury from the sixth thoracic vertebra and above. AD causes various symptoms including paroxysmal hypertension due to stimulus. Here, we report a case of recurrent AD associated with cervical spinal cord tumor. Case presentation The patient was a 57-year-old man. Magnetic resonance imaging revealed an intramedullary lesion in the C2, C6, and high Th12 levels. During the course of treatment, sudden loss of consciousness occurred together with abnormal paroxysmal hypertension, marked facial sweating, left upward conjugate gaze deviation, ankylosis of both upper and lower extremities, and mydriasis. Seizures repeatedly occurred, with symptoms disappearing after approximately 30 min. AD associated with cervical spinal cord tumor was diagnosed. Histological examination by tumor biopsy confirmed the diagnosis of gliofibroma. Radiotherapy was performed targeting the entire brain and spinal cord. The patient died approximately 3 months after treatment was started. Conclusions AD is rarely associated with spinal cord tumor, and this is the first case associated with cervical spinal cord gliofibroma. AD is important to recognize, since immediate and appropriate response is required.

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Intraoperative 3T MR Imaging for Spinal Cord Tumor Resection: Feasibility, Timing, and Image Quality Using a “Twin” MR–Operating Room Suite

American Journal of Neuroradiology ◽

10.3174/ajnr.a1134 ◽

2008 ◽

Vol 29 (10) ◽

pp. 1991-1994 ◽

Cited By ~ 6

Author(s):

T.P. Duprez ◽

A. Jankovski ◽

C. Grandin ◽

L. Hermoye ◽

G. Cosnard ◽

...

Keyword(s):

Spinal Cord ◽

Image Quality ◽

Mr Imaging ◽

Operating Room ◽

Spinal Cord Tumor ◽

Tumor Resection ◽

3T Mr

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Disseminated Cryptococcosis revealed by transverse myelitis in Immunocompetent patient: a case report and review of the literature

BMC Neurology ◽

10.1186/s12883-020-1598-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Fangfang Qu ◽

Zhenzhen Qu ◽

Yingqian Lv ◽

Bo Song ◽

Bailin Wu

Keyword(s):

Spinal Cord ◽

Amphotericin B ◽

Transverse Myelitis ◽

Immunocompetent Patient ◽

Lower Limbs ◽

Coxsackie Virus ◽

Gadolinium Contrast ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Cord Injury

Abstract Background Transverse myelitis (TM) is due to inflammatory spinal cord injury with bilateral neurologic involvement, which is sensory, motor, or autonomic in nature. It may be associated with autoimmune disease, vaccination, intoxication and infections. The most common infection cause of TM is Coxsackie virus and Mycoplasma pneumoniae. The cryptococcosis is rare. We present the case of disseminated cryptococcosis revealed by transverse myelitis in an immunocompetent 55-year-old male patient. The literature review is also stated. Case presentation The 55-year-old man suffered from gradual numbness, weakness in both lower limbs and finally paralyzed in the bed. The thoracic spine Computed tomography (CT) was normal, but multiple nodules in the lung were accidentally discovered. Thoracic Magnetic Resonance Imaging (MRI) showed diffused thoracic spinal cord thickening and extensively intramedullary T2 hyper intensity areas. Gadolinium contrast enhanced T1WI showed an intramedullary circle-enhanced nodule at 9th thoracic level. Diagnosis was made by histological examination of the bilateral lung biopsy. The patient was treated successfully with systemic amphotericin B liposome and fluconazole and intrathecal dexamethasone and amphotericin B liposome. Conclusions This is a patient with disseminated cryptococcosis involving the lung, spinal cord and adrenal glands, which is rare in the absence of immunodeficiency.

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Infantile Spinal Cord Tumor: Diagnostic Difficulties. A Case Report

Journal of Pediatric Orthopaedics B ◽

10.1097/00009957-200201000-00001 ◽

2002 ◽

Vol 11 (1) ◽

pp. 1-5

Author(s):

Taichi Tsuji ◽

Yukihiro Matsuyama ◽

Koji Sato ◽

Hisashi Iwata

Keyword(s):

Spinal Cord ◽

Case Report ◽

Spinal Cord Tumor ◽

Diagnostic Difficulties

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An upper thoracic spinal cord tumor presenting as hemifacial hyperhidrosis

Surgical Neurology ◽

10.1016/j.surneu.2006.10.067 ◽

2007 ◽

Vol 68 (4) ◽

pp. 461-463 ◽

Cited By ~ 10

Author(s):

Cumhur Kilinçer ◽

Levent Öztürk ◽

M. Kemal Hamamcioglu ◽

Emre Altunrende ◽

Sebahattin Çobanoglu

Keyword(s):

Spinal Cord ◽

Spinal Cord Tumor ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Upper Thoracic

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Intradural spinal endoscopy in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.4.peds10533 ◽

2011 ◽

Vol 8 (1) ◽

pp. 107-111 ◽

Cited By ~ 14

Author(s):

Joshua J. Chern ◽

Amber S. Gordon ◽

Robert P. Naftel ◽

R. Shane Tubbs ◽

W. Jerry Oakes ◽

...

Keyword(s):

Spinal Cord ◽

Brain Tumors ◽

Arachnoid Cyst ◽

Spinal Cord Tumor ◽

Split Cord Malformation ◽

Type Ii ◽

Pediatric Spine ◽

Spinal Cord Malformation ◽

Wide Acceptance ◽

Surgical Adjunct

Intracranial endoscopy in the treatment of hydrocephalus, arachnoid cysts, or brain tumors has gained wide acceptance, but the use of endoscopy for intradural navigation in the pediatric spine has received much less attention. The aim of the authors' present study was to analyze their experience in using spinal endoscopy to treat various pathologies of the spinal canal. The authors performed a retrospective review of intradural spinal endoscopic cases at their institution. They describe 4 representative cases, including an arachnoid cyst, intrinsic spinal cord tumor, holocord syrinx, and split cord malformation. Intradural spinal endoscopy was useful in treating the aforementioned lesions. It resulted in a more limited laminectomy and myelotomy, and it assisted in identifying a residual spinal cord tumor. It was also useful in the fenestration of a multilevel arachnoid cyst and in confirming communication of fluid spaces in the setting of a complex holocord syrinx. Endoscopy aided in the visualization of the spinal cord to ensure the absence of tethering in the case of a long-length Type II split spinal cord malformation. Conclusions Based on their experience, the authors found intradural endoscopy to be a useful surgical adjunct and one that helped to decrease morbidity through reduced laminectomy and myelotomy. With advances in technology, the authors believe that intradural endoscopy will begin to be used by more neurosurgeons for treating diseases of this anatomical region.

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