Abstract
Intramedullary spinal cord tumors and cavernous malformations are rare lesions that can lead to progressive neurologic deficits, impaired quality of life, and even death. Early diagnosis and surgical resection of spinal cord tumors and cavernous malformations are often quoted as essential to optimizing a patient’s functional outcome. Unfortunately, these are high-risk operations, with many patients having worse neurological deficits after surgery - sometimes permanent.We present a case of a patient with a cervical intramedullary spinal cord lesion that almost completely resolved spontaneously at short-term follow-up and remained stable at longe-term follow up. Conservative management with careful observation and sequential imaging should be considered in patients with intramedullary spinal cord lesions presenting with acute onset, stable symptoms, especially if the lesion has a hemorrhagic component.
Highlights
Intramedullary spinal cord tumors are rare, representing only 20%-30% of all primary spinal cord tumors [1]
Intramedullary spinal cord tumors and cavernous malformations are rare lesions that can lead to progressive neurologic deficits, impaired quality of life, and even death
We present a case of a patient with a cervical intramedullary spinal cord lesion that almost completely resolved spontaneously at short-term follow-up and remained stable at longe-term follow up
Summary
Intramedullary spinal cord tumors are rare, representing only 20%-30% of all primary spinal cord tumors [1]. Diagnosis and surgical intervention have been quoted as essential to optimizing a patient’s functional outcome [3] These are high-risk operations, with 9% to 34% of patients experiencing worsening neurologic deficits following surgery. A 28-year-old man with no significant past medical history presented with neck pain and right arm dysfunction His symptoms started one month prior to presentation when he awoke with right-sided neck pain and numbness in his right forearm and hand. His symptoms progressed to include right-hand clumsiness and weakness two weeks prior to presentation His exam was notable for 4+/5 weakness throughout his right upper extremity and diffuse numbness across all dermatomes of the right arm and hand. Repeat MRI six weeks later demonstrated almost complete resolution of the lesion (Figures 1C-3C) This was accompanied by clinical improvement in the patient’s right arm clumsiness and numbness. An additional MRI three months later showed no change and the patient continued to clinically improve
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