P50. An extraordinary hour glass forming enhancing mass in the neuroforamina L2/3 with spontaneously complete remission

Abstract

A 46 year old patient presented with a since 4 weeks progressive lumbar pain, which radiate to the left ventral thigh down to the knee, since 2 weeks additionally sensory changes in this location. Apart from Crohn’s disease there are no further illnesses known in the patient’s history. The clinical-neurological results show numbness and paresthesia in the left ventral thigh, no paresis and normal deep tendon reflexes. No signs of herpetiform skin disorders. The MRI scan of the lumbar spine showed an hour glass forming gadolinium enhancing mass with intra- and extradural parts between the 2nd and 3rd lumbar vertebrae on the left side ( Fig. 1 , Fig. 2 ), interpretated most likely as a schwannoma. Laboratory chemistry results were without adverse findings. CRP, blood sedimentation rate, ACE, HIV serology, VZV serology and serology of borreliosis were all negative. The liquor findings were also normal, no intrathecal immunglobuline synthesis, no oligoclonal bands. In the following 2 months the symptoms came into complete remission spontaneously. The follow-up- MRI scan also showed surprisingly also a complete remission of the enhancing mass. Discussion The case report describes a typical radicular syndrome, the correlation in the MRI was an hour glass forming enhancing mass, primarily interpretated as a schwannoma. Through the complete clinical remission and remission in MRI, a neoplasma could be ruled out. Possible differential diagnoses are a radiculitis or an atypical intervertrebral disc prolapse. Gadolinum uptake in the MRI and the lack of evidence of the enhancing mass in the MRI at follow-up are arguments against an intervertebral disc prolapse, the normal liquor findings against a radiculitis. That’s why an exact assignment of the symptoms was therefore impossible and can be discussed.