Abstract
Patients with spinal abnormalities infrequently present with intradural intramedullary bleeding. The more common causes include spinal trauma, arteriovenous malformations and saccular aneurysms of spinal arteries. On occasion, spinal cord tumors either primary or metastatic may cause intramedullary bleed with ependymoma of the conus medullaris. Spinal nerve sheath tumors such as schwannomas only rarely cause intradural intramedullary bleed, especially in the absence of spinal cord or nerve root symptoms. We report a case of spinal intradural schwannoma presenting with acute onset of quadriparesis. Cerebral angiography studies were negative but magnetic resonance imaging (MRI) of the spine revealed a large hemorrhagic tumor in the thoracolumbar junction. However, we suggest that the patients with intradural intramedullary bleed should be evaluated for underlying spine disease.
Highlights
Spinal schwannomas are slow growing spinal nerve sheath benign tumors
We report a case of thoracolumbar intradural intramedullary schwannoma with acute hemorrhage in an adult male patient who had acute onset of quadriparesis
Primary spinal cord tumors are classified based on their locations as extradural, intramedullary and intradural extramedullary
Summary
Spinal schwannomas are slow growing spinal nerve sheath benign tumors These are diagnosed by either imaging studies incidentally or after manifesting symptoms like a backache and progressive neurological deficit [1]. These tumors are seen commonly in intradural extramedullary location and in fourth to the sixth decade of life. Axial T2- [A] and T1-weighted [B] images show hyperintense subdural blood collections located both anterior and posterior (red arrows) to the cauda equina. Coagulation parameters at the time of presentation were within normal limits She underwent a thoracic laminectomy, exploration of the subdural space, evacuation of a compressive intradural intramedullary hematoma and resection of thoracic schwannoma. There were many sessions done for physiotherapy involving venous pumps, therapeutic limp physio, and positioning
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