Abstract
A-41-year old man presented with violent thunderclap headache and a bilateral proprioceptive sensibility deficit of the upper limbs. Cerebral CT scan and MRI were negative. Lumbar puncture confirmed subarachnoid hemorrhage (SAH), but cerebral angiography was negative. Three months later, the patient presented with paraparesis, and a thorough work-up revealed a diffuse, anaplastic extramedullary C7-D10 ependymoma with meningeal carcinomatosis considered the source of hemorrhage. The patient went through a D5-D8 laminectomy, temozolomide chemotherapy, and radiotherapy. The situation remained stable for a few months. In this paper, we would like to emphasize that spinal masses should be considered in cases of SAH with negative diagnostic findings for aneurysms or arteriovenous malformation.
Highlights
Subarachnoid hemorrhage (SAH) is normally due to intracranial lesions
A-41-year old man presented with violent thunderclap headache and a bilateral proprioceptive sensibility deficit of the upper limbs
The patient presented with paraparesis, and a thorough work-up revealed a diffuse, anaplastic extramedullary C7-D10 ependymoma with meningeal carcinomatosis considered the source of hemorrhage
Summary
Subarachnoid hemorrhage (SAH) is normally due to intracranial lesions (mostly aneurysms of vascular malformation). SAH due to spinal lesions is less common and mostly a consequence of a spinal trauma or arteriovenous malformation [1, 2]. Spinal masses account for a very small minority of SAH and include ependymoma, meningioma, metastasis, or hemangioblastoma [3]. We consider this case important, as it may propose a clearer strategy concerning the work-up for subarachnoid hemorrhage. Lumbar puncture remains a useful diagnostic tool when initial CT scan does not show any SAH. Investigations for spinal masses must be performed with negative cerebral angiography
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