scholarly journals Clinical Reasoning: Longitudinally Extensive Spinal Cord Lesions in a Middle-aged Man

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013260
Author(s):  
Nina Xie ◽  
Yafang Zhou
Keyword(s):  
Spinal Cord ◽  
Molecular Analysis ◽  
Cord Compression ◽  
Intermittent Fever ◽  
Limb Weakness ◽  
Lumbosacral Spinal Cord ◽  
History Of ◽  
Intradural Extramedullary ◽  
Fdg Pet Ct ◽  
Extraosseous Ewing’S Sarcoma

An immunocompetent 47-year-old man presented with a five-month history of progressive lower limb weakness, back pain, sphincter dysfunction, and intermittent fever, suggesting myelopathy in a chronic deteriorating course. A comprehensive analysis comprising of blood tests, neuroimaging, CSF profiling, molecular analysis, and histopathology was performed. Notably, enhanced spinal cord MRI revealed longitudinally extensive intradural-extramedullary lesions involving the cervical, thoracic, and lumbosacral spinal cord, with homogeneous enhancement and spinal cord compression. Serum TPHA and RPR tests were positive. CSF profiling showed pleocytosis, significant protein elevations, hypoglycorrhachia, and positive TPHA test. 18F-FDG-PET/CT indicated slightly increased intraspinal FDG uptake. Spinal cord biopsy further showed small round blue cells in poorly differentiated tissues. Immunostaining was positive for NKX2.2, CD56, CD99, Synaptophysin, and Ki67 (50%). Molecular analysis detected a novel MALAT-CYSLTR1 fusion protein and variants in oncogenic genes including PTCH1, TERT, CREBBP, SPEN, and STK11. The diagnosis of intraspinal extraosseous Ewing’s sarcoma (ES) was confirmed. Briefly, our case details the diagnosis of a patient with intradural-extramedullary ES and highlights the value of spinal cord biopsy in progressive myelopathy of unknown causes.

scholarly journals Immediate Response to Chemotherapy in an Adult Neuroblastoma Patient Presenting with Cord Compression

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Nedal Bukhari ◽  
Bachar Harfouch ◽  
Majid Shallal Alotaibi ◽  
Hulayel Al-Harbi ◽  
Omar Chamdine
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Response To Chemotherapy ◽  
History Of ◽  
Bilateral Lower Limb ◽  
The Right ◽  
Neuroblastoma Patient

We report a case of a 31-year-old female patient with high-risk neuroblastoma (NBL) who presented with a history of static back pain and bilateral lower limb weakness for almost a month. Her primary tumor was located in the right paraspinal region, causing spinal cord compression (SCC). Chemotherapy was administered with an immediate clinical improvement noted after 24 hours of starting treatment. We herein report the efficacy of chemotherapy in an adult neuroblastoma (aNBL) patient presenting with spinal cord compression.

scholarly journals Intradural extramedullary tuberculoma of the thoracic spine – A rare case report of paraparesis

2021 ◽  
Vol 12 ◽  
pp. 136
Author(s):  
Boris Kangabam ◽  
Thokchom Amataleima ◽  
Mayanglambam Amitkumar ◽  
Takhelmayum Umesh
Keyword(s):  
Spinal Cord ◽  
Immune Reaction ◽  
Spinal Tuberculosis ◽  
Cord Compression ◽  
Rare Form ◽  
The Past ◽  
Immunodeficiency Virus ◽  
Rare Case Report ◽  
History Of ◽  
Intradural Extramedullary

Background: Intradural extramedullary tuberculoma of the spinal cord (IETSC) is an extremely rare form of spinal tuberculosis (TB) that is believed to be due to a host’s immune reaction against the Mycobacterium protein derivatives. Case Description: A 25-year-old male with human immunodeficiency virus, hepatitis C virus, and disseminated TB on antitubercular therapy for the past 8 months, presented with paraplegia of 2 months duration. When the MRI spine revealed multiple peripheral rim enhancing intradural extramedullary lesions from T6 to T8 and dorsally from T10 to T11, the patient was diagnosed with IETSC. At surgery, we countered cystic lesions adherent to the dura and the spinal cord, containing a whitish material. Postoperatively, the patient showed clinical improvement in motor power and sensation. Conclusion: Intradural extramedullary spinal tuberculomas in patients with a history of TB and spinal cord compression, although rare, should be considered among the differential diagnoses.

scholarly journals Spinal nephroblastoma in a dog: a case report

2019 ◽  
Vol 70 (3) ◽  
pp. 1737
Author(s):  
P. KAMPOURI ◽  
A. KARIKI ◽  
R.D. BAKA ◽  
M.N. PATSIKAS ◽  
Z.S. POLIZOPOULOU
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Histopathological Examination ◽  
Weight Bearing ◽  
Cord Compression ◽  
Posterior Limb ◽  
Fluid Analysis ◽  
Left Posterior ◽  
History Of ◽  
Intradural Extramedullary

The case report presents the clinical, clinicopathological, diagnostic imaging and histopathological findings of spinal cord nephroblastoma in a dog. It was admitted with a 2-week history of a “weight-bearing” lameness of the left posterior limb that evolved to paraplegia within hours. Neurological examination showed spastic paraplegia compatible with a T3-L3 spinal cord lesion. Differential diagnosis included ischemic myelopathy, myelitis and acute spinal cord compression. The spinal radiographs and cerebrospinal fluid analysis were unremarkable. Cisternal myelography indicated a focal intradural-extramedullary lesion at the level of T12 vertebra. Further diagnostic investigation was not performed because the owner decided to proceed to euthanasia. Histopathological examination of the spinal cord confirmed the diagnosis of intraspinal nephroblastoma.

Intradural Extramedullary Surgical Lysis of an Arachnoid Web of the Spine: 2-Dimensional Operative Video

2019 ◽  
Author(s):  
Ibrahim Hussain ◽  
Peyton L Nisson ◽  
Samuel Kim ◽  
Ali A Baaj
Keyword(s):  
Spinal Cord ◽  
Cord Compression ◽  
Preoperative Imaging ◽  
Rapid Improvement ◽  
Left Lower Extremity ◽  
History Of ◽  
Intradural Extramedullary ◽  
Computed Topography ◽  
Neurologically Intact

Abstract Arachnoid web of the spine (AWS) is a rare and subtle lesion that can have severe neurological consequences. Patients typically present with progressive myelopathic symptoms and have no more than a slight indentation of spinal cord on imaging, commonly referred to as the “scalpel sign.” A unique feature associated with this lesion is the extent of (and sometimes the rapidity of) the recovery that occurs following treatment. In this operative video, we highlight the treatment of a 32-yr-old male with a history of lumbar spondylosis, who, over a 2 wk period, developed progressive spasticity and weakness of the entire left lower extremity and left foot numbness. Magnetic resonance imaging revealed a T4-T5 “scalpel sign” and spinal cord compression on computed topography myelogram, which was subsequently taken to the operating theater. The major steps in this video include the following: A) a summary of the patient's presentation and preoperative imaging, B) the technical steps in the surgical lysis of the AWS, and C) his postoperative course. The patient tolerated the procedure well, demonstrating a rapid improvement in symptoms postoperative day 1. At the time of most recent follow-up (4 mo), the patient remains neurologically intact with a full return to his neurologic baseline. Surgical lysis of AWS demonstrated to be a curative procedure with rapid neurological recovery, showing no signs of recurrence or regression. Consent was given by the patient for the use of deidentified images and the intraoperative video for educational purposes at the time consent was obtained for the surgical procedure, in accordance with our institution's policy.

Resection of 2 Intradural Extramedullary Cervical Spine Tumors in a Patient With Neurofibromatosis Type 2: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. 274-274
Author(s):  
Simone E Dekker ◽  
Chad A Glenn ◽  
Thomas A Ostergard ◽  
Osmond C Wu ◽  
Fernando Alonso ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Treatment Options ◽  
Tumor Resection ◽  
Neurofibromatosis Type ◽  
Cord Compression ◽  
Neurofibromatosis Type 2 ◽  
3 Dimensional ◽  
Intradural Extramedullary

Abstract This 3-dimensional operative video illustrates resection of 2 cervical spine schwannomas in a 19-yr-old female with neurofibromatosis type 2. The patient presented with lower extremity hyperreflexity and hypertonicity. Magnetic resonance imaging (MRI) demonstrated 2 contrast-enhancing intradural extramedullary cervical spine lesions causing spinal cord compression at C4 and C5. The patient underwent a posterior cervical laminoplasty with a midline dural opening for tumor resection. Curvilinear spine cord compression is demonstrated in the operative video. After meticulous dissection, the tumors were resected without complication. The dural closure was performed in watertight fashion followed by laminoplasty using osteoplastic titanium miniplates and screws. Postoperative MRI demonstrated gross total resection with excellent decompression of the spinal cord. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.

Extradural Thoracic Arteriovenous Malformation in a Patient with Klippel-Trenaunay-Weber Syndrome: Case Report

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1275-1279 ◽  
Author(s):  
Michael J. Alexander ◽  
Peter M. Grossi ◽  
Robert F. Spetzler ◽  
Cameron G. McDougall
Keyword(s):  
Spinal Cord ◽  
Cord Compression ◽  
Magnetic Resonance Imaging Scan ◽  
Lower Extremity Weakness ◽  
Thyrocervical Trunk ◽  
Weber Syndrome ◽  
History Of ◽  
Cutaneous Hemangioma ◽  
The Right ◽  
Upper Thoracic

Abstract OBJECTIVE AND IMPORTANCE Spinal cord involvement in Klippel-Trenaunay-Weber (KTW) syndrome is rare. Cases of intradural spinal cord arteriovenous malformations (AVMs) have been associated with this syndrome. Likewise, cases of epidural hemangioma and angiomyolipoma have been reported to occur at the same segmental level as cutaneous hemangioma in KTW syndrome. This report details a rare case of an extradural thoracic AVM in a patient with KTW syndrome. CLINICAL PRESENTATION A 30-year-old man presented with a 10-month history of progressive myelopathy, bilateral lower-extremity weakness, and numbness, with the right side affected more than the left. His symptoms had progressed to the point that he was unable to walk. The patient had the characteristic manifestations of KTW syndrome, including numerous cutaneous angiomas and cavernomas, limb hypertrophy and syndactyly, and limb venous malformations. A magnetic resonance imaging scan and subsequent angiogram demonstrated a large extradural AVM causing cord compression at the T3–T4 levels. INTERVENTION The patient underwent two separate endovascular procedures, including embolization of upper thoracic and thyrocervical trunk feeders. Subsequently, he underwent T1–T4 laminectomy and microsurgical excision of the AVM. Clinically, the patient improved such that he could walk without assistance. CONCLUSION KTW syndrome represents a spectrum of clinical presentations. Although involvement of the spinal cord is uncommon, the manifestations of this syndrome may include both intradural and extradural AVMs in addition to various tumors.

scholarly journals Initial presentation of Hodgkin’s Lymphoma as Extradural Spinal Cord Compression: A case report

2020 ◽  
Vol 11 (2) ◽  
pp. 101-103
Author(s):  
Rishav Mukherjee ◽  
Sampurna Chowdhury
Keyword(s):  
Spinal Cord ◽  
Hodgkin Lymphoma ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Acute Onset ◽  
Initial Presentation ◽  
Classical Hodgkin Lymphoma ◽  
Night Sweats ◽  
History Of ◽  
Mediastinal Widening

A 23 year old female presented with acute onset paraparesis. She denied any history of fever, weight loss or drenching night sweats. Neither did she have any obvious lymphadenopathy on general examination. Chest Xray was however suggestive of mediastinal widening and her MRI spine showed metastases with superior mediastinal SOL. Biopsy of this SOL ultimately revealed classical Hodgkin lymphoma. Thus this was a very unusual initial presentation of Hodgkin lymphoma presenting as Epidural Spinal Cord Compression. Hasenclever IPS score was 2. Patient was treated with radiotherapy followed by ABVD chemotherapy and achieved remission in 3months.

Primary polymorphous hemangioendothelioma of the spinal cord

2001 ◽  
Vol 95 (1) ◽  
pp. 93-95 ◽  
Author(s):  
Federico Roncaroli ◽  
Bernd W. Scheithauer ◽  
Savvas Papazoglou
Keyword(s):  
Spinal Cord ◽  
Vascular Tumor ◽  
Nerve Roots ◽  
Content Type ◽  
Sensorimotor Deficit ◽  
History Of ◽  
Intradural Extramedullary ◽  
Borderline Malignancy ◽  
Current Experience

✓ A case of polymorphous hemangioendothelioma of the spinal cord is described. This 55-year-old woman presented with an 18-month history of lower-extremity sensorimotor deficit. A magnetic resonance image revealed an enhancing, intradural, extramedullary nodule at the T1–2 level. On gross inspection, the lesion measured 3.5 cm and was firmly attached to spinal cord parenchyma and adjacent nerve roots. It was completely removed. Fourteen months after surgery the patient's neurological deficit had resolved. Polymorphous hemangioendothelioma is a rare vascular tumor of borderline malignancy. Most occur in lymph nodes. None has been reported to occur in the central and peripheral nervous system. Based on current experience, resection and close follow up seems the best therapeutic approach.

Spinal cord compression due to intradural extramedullary aspergilloma and cyst: A case report

1989 ◽  
Vol 31 (4) ◽  
pp. 315-318 ◽  
Author(s):  
George Cravens ◽  
Hugh Robertson ◽  
Charles Banta ◽  
Carlos Garcia ◽  
Pamela Neville
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Intradural Extramedullary

Impact of Myelography on the Radiotherapeutic Management of Malignant Spinal Cord Compression

Neurosurgery ◽  
1986 ◽  
Vol 19 (4) ◽  
pp. 614-616 ◽  
Author(s):  
Alison R. Calkins ◽  
Margaret A. Olson ◽  
James H. Ellis
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Additional Information ◽  
Compression Syndrome ◽  
Plain Films ◽  
Port Design ◽  
Bony Lesions ◽  
History Of ◽  
Spinal Cord Compression Syndrome

Abstract From December 1981 through August 1984, 24 patients with spinal cord compression syndrome due to epidural neoplasms were evaluated for radiotherapy with clinical examination, radiographs of the spine, and myelography. All plain films were reviewed, and mock radiotherapy fields designed using specific criteria for margins. The same patients were reviewed a second time considering the additional information provided by myelography. The initial treatment fields were found to be inadequate in 69% of the patients. Even in patients with discrete bony lesions, the results of myelography affected the treatment 45% of the time. A history of previous spinal irradiation significantly influenced port design in only 1 of the 7 patients who had received previous radiotherapy. Although invasive, myelography is essential in planning the treatment of spinal cord compression.

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