A Rare Case of Cavernous Angioma of the Cauda Equina with Spinal Subarachnoid Hemorrhage in a Patient with Multiple Brain Cavernomatosis. Case Report and Review of Literature

Abstract

Objective: To report a rare case of cavernous angioma of the cauda equina with signs of intratumoral and subarachnoid hemorrhage in a patient affected by multiple brain cavernomatosis, and to discuss the clinicoradiological and surgical features of these uncommon lesions using the data available in the literature. Summary of Background Data: Cavernous angiomas of the cauda equina are extremely rare lesions, accounting for only 5% to 12% of all vascular lesions of the spine, and rarely cause spinal subarachnoid hemorrhage. Including the present, only 27 cases are reported in literature. Methods: A case report and review of the literature. Results: A 50 year-old female with history of multiple brain cavernomatosis, presented with low back pain, paraparesis and lower limb hypoesthesia from six months. MRI scans showed a well defined intradural extramedullary mass in the cauda equine at L2 level, with signs of subarachnoid hemorrhage in L5-S1. An “en-bloc” removal of the lesion was performed. The patient was discharged with no neurological deficit. MRI scan 6 months after surgery showed total excision of the lesion with no recurrence. Conclusion: Cavernous angiomas of the cauda equine associated with multiple cerebral cavernous angiomas are extremely rare lesions. They may present low back pain, sciatica, neurologic deficit and subarachnoid hemorrhage. They can be successfully surgically removed in order to prevent bleeding and dangerous enlargement of the lesion.