Spinal cord compression with acute para-paresis due to thoracic aneurysmal bone cyst (ABC): a case report and review of the literature

Aneurysmal bone cysts (ABCs) are benign, highly vascular osseous lesions characterized by cystic, blood-filled spaces surrounded by thin perimeters of expanded bone. Children and young adults are most often affected by spinal ABCs; more than 75% of patients are younger than 20 years old at the time of presentation. Although ABCs have been documented in all areas of the axial and appendicular skeleton, ABCs of the spine present unique challenges due to the risk of vertebral destabilization, pathological fracture, and vertebral body (VB) collapse with neurological compromise. We describe here a case of a 12-year-old child who presented with cervical pain and gait disturbances starting a few weeks prior to his admission with acute paraparesis at the time of admission. Subsequently he was found to have a Thoracic ABC involving T1-T3.This was accompanied by T2 vertebral body collapse and spinal cord compression. He was investigated and treated promptly by resection of the aneurysmal bone cyst with posterior Cervical-thoracic instrumentation. There was full post-operative neurological resolution.

Acute thrombosis of a giant perimedullary arteriovenous fistula in a pediatric HHT patient

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant hereditary disorder that results in arteriovenous malformations (AVMs) in the nose, mucocutaneous surfaces and visceral organs, including lung, brain, liver, bowel and rarely spinal cord. We describe a case of a young child with HHT who presented with acute paraparesis due to acute thrombosis of a spinal perimedullary arteriovenous fistula. Patient underwent coil embolization of spinal arteriovenous shunt with resolution of clinical symptoms. This case highlights the possibility of catastrophic complications in young children with HHT, the potential preventive role of screening for spinal AVMs in HHT and the importance of timely intervention.

Brown tumor due to primary hyperparathyroidism resulting in acute paraparesis: Case report and literature review

Background: Brown tumor (Osteoclastoma) is a rare benign, focal, lytic bone lesion most commonly attributed to a parathyroid adenoma; it occurs in approximately 5% of patients with primary hyperparathyroidism, and 13% of patients with secondary hyperparathyroidism. Most tumors are located in the mandible, pelvis, ribs, and large bones; only rarely is it found in the axial spine. Case Description: A 37-year-old male with primary hyperparathyroidism presented with an MR-documented T4 and T5 brown tumor (Osteitis Fibrosa Cystica) resulting in an acute paraparesis. The patient successfully underwent excisional biopsy of an expansile, enhancing, bony destructive lesion at the T4-5 level. Subsequently, he required subtotal excision of a left upper parathyroid tumor. Conclusion: Patient with primary hyperparathyroidism may acutely present with paraparesis attributed to brown tumors of the spine warranting emergent operative decompression.

Acute Paraparesis after Epidural Corticosteroid Injection Revealing Spinal Dural Arteriovenous Fistula in a HIV Patient

Spinal dural arteriovenous fistulas (SDAVFs) are often misdiagnosed as their symptoms are non-specific, leading to treatment delay and a poor outcome. We describe the case of a 53-year-old man with a history of progressive paraparesis that worsened abruptly after an epidural corticosteroid injection. We highlight here the need for high diagnostic suspicion for an SDAVF in patients deteriorating after an epidural injection and an indication of repeated spine imaging in such cases. Finally, this is the first reported case of an SDAVF in a HIV-positive patient and it emphasizes the need for a broad differential diagnosis.

Spinal dural arteriovenous fistula masquerading as subdural hematoma

Background: This case highlights an angiographically occult spinal dural AVF presenting with a spinal subdural hematoma. While rare, it is important that clinicians be aware of this potential etiology of subdural hematomas before evacuation. Case Description: A 79-year-old female presented with acute lumbar pain, paraparesis, and a T10 sensory level loss. The MRI showed lower cord displacement due to curvilinear/triangular enhancement along the right side of the canal at the T12-L1 level. The lumbar MRA, craniospinal CTA, and multivessel spinal angiogram were unremarkable. A decompressive exploratory laminectomy revealed a subdural hematoma that contained blood products of different ages, and a large arterialized vein exiting near the right L1 nerve root sheath. The fistula was coagulated and sectioned. Postoperatively, the patient regained normal function. Conclusion: Symptomatic subdural thoracolumbar hemorrhages from SDAVF are very rare. Here, we report a patient with an acute paraparesis and T10 sensory level attributed to an SDAVF and subdural hematoma. Despite negative diagnostic studies, even including spinal angiography, the patient underwent surgical intervention and successful occlusion of the SDAVF.

A Spontaneous Spinal Epidural Hematoma Case Report

Hematoma epidural spinal spontan atau spontaneous spinal epidural hematoma (SSEH) adalah akumulasi darah di ruang epidural tulang belakang yang menekan medula spinalis dan menimbulkan defisit neurologis. SSEH dapat terjadi di segmen mana saja dari medula spinalis dan penyebab pasti serta sumber perdarahan yang pasti hingga saat ini masih belum diketahui. Diagnosis SSEH dapat ditegakkan dengan pemeriksaan penunjang MRI. Tatalaksana pilihan untuk kasus SSEH adalah laminektomi dekompresi dan evakuasi hematoma. Pada kasus ini, pasien datang dengan keluhan paraparesis inferior tipe UMN dan gangguan sensibilitas yang akut tanpa riwayat trauma dan faktor risiko yang berhubungan dengan SSEH. Pasien menjalani laminektomi dan menunjukkan perbaikan klinis yang signifikan. Spontaneous spinal epidural hematoma (SSEH) is an accumulation of blood in epidural space of the spine compressing spinal cord and causing neurological deficits. SSEH can occur in any segments of the spinal cord and the definite etiology and source of bleeding is still unknown until now. MRI can be used to support SSEH diagnosis. Treatment of choice for SSEH cases is decompression laminectomy and hematoma evacuation. In this case, the patient came with acute paraparesis upper motor neuron type and sensibility disturbances, without history of trauma and any risk factors associated with SSEH. The patient underwent laminectomy and showed significant clinical improvement.

Intradural spinal arachnoid cyst contributing to sudden paraparesis

Background: Spinal arachnoid cysts are cystic lesions filled with cerebrospinal fluid that contributes to neurological deficits depending on their size/location within the spinal canal. Here, we report a patient with a spinal subarachnoid cyst who suddenly developed paraparesis. Case Description: A 37-year-old female with a thoracic spinal arachnoid cyst at the T7 level suddenly developed lower abdominal pain followed by immediate paraparesis. Two weeks following the onset of symptoms, she underwent a T6-T8 laminectomy; this included with full cyst excision. By the 4th postoperative week, her signs/symptoms fully resolved. Conclusions: A 37-year-old female with a T7 thoracic spinal subarachnoid cyst who presented with acute paraparesis regained normal function 2 weeks following a T6-T8 laminectomy.