Intramedullary Cavernoma: Case Report and Literature Review

Introduction: Cavernomas are benign vascular anomalies consisting of cavities where the blood circulates at low flow and at low pressure. Intramedullary localization is unusual, represents approximately 5 to 12% of spinal vascular malformations and 3% of intra-dural vascular malformations (5% of medullary vascular lesions). Observation: A patient, aged 59, consulted for the abrupt installation of moderate back pain followed by predominant muscle weakness in the two lower limb of progressive worsening, responsible for gait disorders. The patient reported thermal hypoesthesia and heaviness of the two lower limbs that had been evolving for two years. The examination found a dorsal spinal cord compression syndrome. On the MRI, there were abnormalities of intramedullary signal of the dorsal (D11) spinal cord with bleeding stigmas suggestive of intramedullary cavernomas. Conclusion: The management of the medullary cavernoma is essentially neurosurgical with complete microsurgical resection of the malformation. In the absence of surgical treatment, evolution can be to chronic myelopathy or neurological aggravation.

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Introduction: Spinal Vascular Malformations

Neurosurgical FOCUS ◽

10.3171/foc.2009.26.1.e1 ◽

2009 ◽

Vol 26 (1) ◽

pp. E1 ◽

Cited By ~ 2

Author(s):

Edward H. Oldfield

Keyword(s):

Spinal Cord ◽

Vascular Malformations ◽

Vascular Lesions ◽

Successful Management ◽

Anatomical Features ◽

Spinal Vascular Malformations ◽

Cord Injury ◽

Selective Arteriography ◽

The 1960S ◽

Made In

From the earliest observations of spinal vascular malformations, successful management has been challenging. Initially the challenges were diagnosing, understanding, and treating these lesions. They were originally considered all to be the same, or at least to be a single general type, of disease. With the introduction of selective spinal arteriography in the 1960s and more recently with the introduction and widespread use of MR imaging, the initial challenge of diagnosing spinal vascular malformations was overcome, and significant progress has been made in understanding their anatomy as well as the pathophysiology that underlies the myelopathy commonly associated with them. The anatomical features defined by selective arteriography and the observations permitted with the operating microscope ultimately led to distinctions between the major categories of the vascular lesions affecting the spinal cord; these distinctions were based on the lesions' anatomy, epidemiology, and the mechanism of spinal cord injury.

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Report of a case of Cobb syndrome: multimodality imaging

BJR|case reports ◽

10.1259/bjrcr.20200145 ◽

2020 ◽

pp. 20200145

Author(s):

Dalia Ibrahim ◽

Shady Mashhour

Keyword(s):

Upper Limb ◽

Vascular Malformations ◽

Multimodality Imaging ◽

Skin Lesions ◽

Cord Compression ◽

Low Flow ◽

Vascular Lesions ◽

Cervical Cord ◽

Limb Weakness ◽

The Right

Cobb syndrome is a rare vascular disorder characterized by vascular skin lesions distributed in a dermatomal pattern, with corresponding muscular, osseous, paraspinal, and/or spinal vascular lesions occurring at the same body somite (metamere). We present a case of a 25-year-old man who presented with a history of right upper limb paresthesia followed by bilateral progressive upper and lower limb weakness and heaviness. Physical examination showed large cutaneous port wine stains on the right side of the chest, the nape, and along the whole right upper limb in a dermatomal distribution, with no corresponding limb hypertrophy or asymmetry. MRI and CT scan of the cervical spine showed aggressive vertebral hemangiomas involving the right side of C1 down to C4 vertebrae associated with extraosseous epidural lesion causing cervical cord compression, in addition to right paraspinal muscular low flow vascular malformations. Digital subtraction angiography of the neck vessels showed corresponding vascular blush and delayed contrast pooling in the affected regions. Cobb syndrome was diagnosed based on the dermatomal distribution of the cutaneous vascular lesions and the corresponding vertebral, epidural, and paraspinal vascular lesions occurring at the same metamere. The patient underwent a decompressive laminectomy at C2–C6 levels with removal of the epidural lesion, after which his symptoms had improved.

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3D DCE-MRA in spinal vascular malformations

10.21203/rs.3.rs-439058/v1 ◽

2021 ◽

Author(s):

Jibin Cao ◽

Sijia Gao ◽

Wenge Sun ◽

Lingling Cui

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Clinical Symptoms ◽

Vascular Malformations ◽

High Sensitivity ◽

Vascular Lesions ◽

Arterial Blood Supply ◽

3 Dimensional ◽

Spinal Vascular Malformations ◽

Arterial Blood

Abstract Purpose: This study was carried out to investigate whether 3.0T dynamic enhanced 3 dimensional magnetic resonance angiography (3D DCE-MRA) could identify spinal cord vascular malformations efficiently.Material and Methods: 32 suspected cases of spinal vascular disease with MR imaging and clinical symptoms were detected using DCE-MRA. 28 patients were valued through DSA for 3-5 days, and surgical treatment was performed on 24 patients. Results: DCE-MRA was used to examine all the cases which recognized abnormal vascular lesions clearly, and 28 cases were consistent with DSA or surgical diagnosis. The arterial blood supply was evaluated accurately in 28 cases. The findings were correct in 26 cases.Conclusion: 3.0T DCE-MRA features high sensitivity and accuracy in detecting and characterizing SVMs, especially SDAVF.

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Chronic inflammatory demyelinating polyradiculoneuropathy: two cases with cervical spinal cord compression

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2005000400021 ◽

2005 ◽

Vol 63 (3a) ◽

pp. 666-669 ◽

Cited By ~ 6

Author(s):

Marcos R.G. de Freitas ◽

Osvaldo J.M. Nascimento ◽

Cristiane N. Soares ◽

Adriana Rocha Brito ◽

Romeu Cortes Domingues

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cervical Spinal Cord ◽

Cord Compression ◽

Spinal Nerve ◽

Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽

Lower Limbs ◽

Peripheral Nerve Disorder ◽

Spinal Roots ◽

Spinal Cord Compression Syndrome

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a peripheral nerve disorder probably due to an immunological disturb. It evolves either in a steadily progressive or in a relapsing and fluctuating course. Weakness is mainly in the lower limbs proximally and distally. The electromyography is demyelinating. The cerebral spinal fluid protein is most of times elevated. Sometimes enlarged nerves are found. There are few cases described with spinal cord compression due to hypertrophic spinal nerve roots. Two patients (females, 66 and 67 years old) with diagnosis of a long standing CIDP are described. In the first one, the evolution was characterized by remission and relapsing course. The second patient had a chronic and progressive course. These patients presented after a long evolution a cervical spinal cord compression syndrome due to hypertrophic cervical roots. Neurologists must be aware of the possibility of development of spinal cord compression by enlarged spinal roots in patients with a long standing CIDP.

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Is there a right time for surgery in paraplegic patients secondary to non traumatic spinal cord compression?

Einstein (São Paulo) ◽

10.1590/s1679-45082012000400020 ◽

2012 ◽

Vol 10 (4) ◽

pp. 508-511 ◽

Cited By ~ 2

Author(s):

Leonardo Giacomini ◽

Roger Neves Mathias ◽

Andrei Fernandes Joaquim ◽

Mateus Dal Fabbro ◽

Enrico Ghizoni ◽

...

Keyword(s):

Spinal Cord ◽

Prognostic Factor ◽

Spinal Cord Compression ◽

Cord Compression ◽

Lower Limbs ◽

Motor Deficit ◽

Indication For Surgery ◽

Sensory Deficits ◽

Sensory Involvement ◽

Spinal Cord Decompression

Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement. The cause of paraplegia usually guides treatment, however, some controversies remain about the time and benefits for spinal cord decompression in nontraumatic paraplegic patients, especially after 48 hours of the onset of paraplegia. The objective of this study was to evaluate the benefits of spinal cord decompression in such patients. We describe three patients with paraplegia secondary to non-traumatic spinal cord compression without sensory deficits, and who were surgically treated after more than 48 hours of the onset of symptoms. All patients, even those with paraplegia during more than 48 hours, had benefits from spinal cord decompression like recovery of gait ability. The duration of paraplegia, which influences prognosis, is not a contra-indication for surgery. The preservation of sensitivity in this group of patients should be considered as a positive prognostic factor when surgery is taken into account.

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Malignant Spinal Cord Compression Syndrome as an Initial Presentation of Testicular Cancer

Case Reports in Oncological Medicine ◽

10.1155/2018/5757434 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Carlos Eduardo Salazar-Mejía ◽

Edio Llerena-Hernández ◽

David Hernández-Barajas ◽

Oscar Vidal-Gutiérrez ◽

Adriana González-Gutiérrez ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Germ Cell Tumors ◽

Rare Event ◽

Cord Compression ◽

Initial Manifestation ◽

Compression Syndrome ◽

Left Testicle ◽

Spinal Cord Compression Syndrome ◽

Hepatic Metastatic Disease

Malignant spinal cord compression syndrome (MSCCS) occurs in 2.5 to 5% of all oncological patients. In 20% of the cases, it is the initial manifestation. This syndrome is a rare event among germ cell tumors (GCT), occurring in only 1.7% of the patients. We present the case of a 24-year-old man who arrived at the emergency department with dysesthesia and paraparesis as well as urinary incontinence. Imaging studies showed an infiltrative lesion in the left testicle, pulmonary and hepatic metastatic disease, and a large retroperitoneal ganglionar conglomerate that infiltrated the spinal cord through the intervertebral foramina of the vertebra level T11 with displacement of the L1 vertebral body. A postoperative biopsy showed a pure embryonal carcinoma. In the initial approach of a young man who presents spinal cord compression, the presence of MSCCS associated with GCT should be considered as a possible cause. A high level of suspicion is required to achieve a timely diagnosis, to grant the patient the best possible outcome.

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Patient-Reported Outcomes–Secondary Analysis of the SCORE-2 Trial Comparing 4 Gy × 5 to 3 Gy × 10 for Metastatic Epidural Spinal Cord Compression

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2019.08.002 ◽

2019 ◽

Vol 105 (4) ◽

pp. 760-764 ◽

Cited By ~ 1

Author(s):

Dirk Rades ◽

Barbara Šegedin ◽

Antonio J. Conde-Moreno ◽

Carlos Ferrer-Albiach ◽

Michaela Metz ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Patient Reported Outcomes ◽

Secondary Analysis ◽

Cord Compression ◽

Patient Reported

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The contributions of Otto Hebold and Julius Gaupp to the study of spinal vascular malformations: Original documents and historical context

Interventional Neuroradiology ◽

10.1177/1591019919845648 ◽

2019 ◽

Vol 25 (6) ◽

pp. 604-612

Author(s):

Philippe Gailloud

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

19Th Century ◽

Vascular Malformation ◽

Vascular Malformations ◽

Historical Context ◽

Journal Articles ◽

Late 19Th Century ◽

Spinal Vascular Malformation ◽

Spinal Vascular Malformations

Book chapters and journal articles dealing with spinal cord vascular malformations often reference Otto Hebold and Julius Gaupp, but frequently misrepresent the observations published by the two German authors in the late 19th century. The purpose of this paper is to provide a better appreciation of these important contributions based on abridged translations of original documents set in their historical context, notably regarding the landmark works of Brasch, Raymond and Cestan, and Lindenmann. It is concluded that Gaupp offered the first reliable description of a perimedullary arteriovenous fistula while the lesion reported by Hebold was not a spinal vascular malformation.

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Volumetric T2-weighted MRI improves the diagnostic accuracy of spinal vascular malformations: comparative analysis with a conventional MR study

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014522 ◽

2019 ◽

Vol 11 (10) ◽

pp. 1019-1023 ◽

Cited By ~ 2

Author(s):

Santhosh Kumar Kannath ◽

Adhithyan Rajendran ◽

Bejoy Thomas ◽

Jayadevan Enakshy Rajan

Keyword(s):

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Vascular Malformations ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Vascular Lesions ◽

Volumetric Mri ◽

Spinal Vascular Malformations ◽

Sensitivity Specificity ◽

T2 Mri

BackgroundTo date, very little study of the importance of a volumetric T2-weighted MR sequence in the evaluation of spinal vascular malformations (SVMs) has been carried out.ObjectiveTo determine the utility and accuracy of a volumetric T2 MR sequence compared with conventional T2 in the diagnosis of SVMs.MethodsRetrospective analysis of all patients who underwent spinal DSA for suspected SVMs was conducted. Conventional T2 and volumetric T2 MR images were analysed for the presence of flow voids and parenchymal changes, and SVMs were characterized. The sensitivity, specificity, and overall diagnostic accuracy of these MRI diagnoses were calculated.ResultsOf 89 subjects included in the final analysis, 70 patients had angiographically proved SVMs (38 patients with spinal cord arteriovenous malformations [SCAVM—intramedullary or perimedullary] and 32 cases of spinal dural arteriovenous fistula (SDAVF)) and the remaining 19 subjects were normal. The sensitivity and specificity for identification of SVMs were 98.1% and 90% for volumetric T2 sequences, compared with 82.8% and 89.4% for conventional T2 MRI, respectively. For characterization of spinal vascular lesions, volumetric MRI showed high sensitivity, specificity, and accuracy for SDAVF (100%, 90%, 97%, respectively) compared with conventional T2 MRI (71.8%, 89%, 79%, respectively). The positive likelihood ratio was high and negative likelihood ratio was zero for volumetric MRI evaluation of SDAVF, while these ratios were comparable between the two sequences for SCAVM.ConclusionVolumetric T2 MRI is highly sensitive for the detection of SVMs, especially for SDAVF. Volumetric T2 MRI could be introduced into routine clinical practice in the screening of suspected SVMs.

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