Subarachnoid Hemorrhage due to Spinal Tumor

Abstract

An unusual case involving subarachnoid hemorrhage (SAH) associated with an ependymoma is presented. The patient, a 54-year-old male, was hospitalized because of sudden onset of severe headache and urinary retention. Cerebral angiography revealed no abnormality. An intraspinal lesion was suspected when serial lumbar punctures repeatedly yielded dark, brownish fluid. Further neuroradiological examinations (myelography, spinal computed tomography, and selective spinal arteriography) revealed an intraspinal tumor situated at L1-3. The tumor was totally removed with the aid of preoperative transcatheter embolization. Only 56 cases of SAH due to an intraspinal neoplasm have been reported. Such cases are thought to be uncommon and, in many of those reported, diagnosis was difficult. The possibility of an intraspinal tumor should be considered in SAH patients who present with minimal spinal cord or root signs. In terms of locating and characterizing the hypervascular spinal tumor in the present case, as well as selecting appropriate treatment, selective spinal arteriography was the most contributory procedure.