Spinal cord compression secondary to spinal extradural myeloid sarcoma in acute myeloid leukaemia: A case report and literature review

Acute lymphoblastic leukemia (ALL) is a neoplastic proliferation of immature hematopoietic cells, commonly presenting with anaemia, thrombocytopenia, neutropenia, or hepatosplenomegaly. Paraplegia as the initial manifestation is extremely rare. We report a 6-year-old girl presenting with backache and sudden paraplegia. MRI revealed a thoracic epidural mass (D1-D6). Tumor excision and laminectomy were performed, and histopathology confirmed B-cell ALL. This case highlights the importance of considering leukemia in children with acute spinal cord compression.

Severe cervical kyphosis concurrent with neurofibromatosis type 1 (NF-1) and large intraspinal tumors presents a dual challenge of oncological control and biomechanical reconstruction. We report a rare case of a 14-year-old male with NF-1 secondary to C1-C6 cervical spondylolisthesis, cervical retroversion, retrolisthesis of the C3 vertebral body (less than 1/2 of the vertebral diameter), C2 dislocation, atlantoaxial rotational dislocation, and a large intradural tumor, which caused acute spinal cord compression and neurofunctional deficits. An integrated surgical strategy combining microsurgical tumor resection with 3D-printed corrective fusion was implemented. Intraoperatively, gross total resection (GTR) of the tumor was achieved, followed by precise pedicle screw fixation assisted by patient-specific 3D-printed guides. This comprehensive approach prevented further neurological damage, and the patient achieved satisfactory clinical outcomes postoperatively. NF-1 is an autosomal dominant genetic disorder with an incidence of 1/3,000–1/4,000, characterized by diverse manifestations including skin abnormalities, neurological tumors, and musculoskeletal abnormalities. Approximately 50% of cases arise from de novo mutations. Case description A 14-year-old Han male student with no prior medical history was admitted for a 1-year history of a large right neck mass (15 × 9 cm) and 2 months of progressive generalized weakness. Physical examination revealed multiple café-au-lait macules (>30 mm) and a large cervical mass, consistent with NF-1. Neurological assessment showed decreased muscle strength in all limbs (grade 3), indicating incomplete spinal cord injury. Imaging (MRI/CT) demonstrated an intradural-intramedullary tumor extending through the intervertebral foramen, causing severe spinal cord compression and multiplanar instability (C1–C6).The patient was diagnosed with NF-1, severe cervical kyphosis, and an intraspinal tumor. He underwent posterior decompression, microsurgical GTR of the tumor (confirmed as neurofibroma via intraoperative frozen section), and occipitocervicothoracic fusion assisted by 3D-printed guides. The integrated surgery successfully restored spinal stability and decompressed the spinal cord. Conclusion Severe cervical retroversion combined with large NF-1 tumors is rare and technically demanding. A precision-medicine-based model integrating tumor management and digital orthopedic technology is essential for such high-risk cases. Preoperative planning using 3D digital technology enabled precise screw placement, while microsurgical techniques ensured safe and complete tumor resection. This integrated strategy effectively prevented permanent neurological deficits and resulted in satisfactory postoperative outcomes.

Background: Spinal hemangiomas are benign tumors that develop mostly in vertebral bodies but their behavior is uncertain. The thoracic spine is the most frequently affected segment by these lesions, followed by the lumbar and cervical levels. Although the vast majority are asymptomatic, aggressiveness in some cases can cause spinal pain, various neurological compromises or spinal instability. Case Description: We present a case in which a previously asymptomatic male patient suffered a craniocervical trauma that caused a severe compression fracture of C5, which manifested clinically and radiologically as a Brown-Sequard syndrome. Due to intraoperative behavior and surgical findings, the bone fragments and the tissue found within them were histologically analyzed, which confirmed the existence of a capillary hemangioma that considerably involved the vertebral body. The surgical treatment and neurological recovery were adequately evaluated with very good results. Conclusions: Vertebral hemangiomas are considered lesions with a well-defined etiology but an uncertain evolution. The clinical characteristics in the case presented are special due to the development of Brown-Sequard syndrome associated with a severe vertebral fracture that contained a previously undetected vertebral hemangioma that could have influenced the weakening of the fractured vertebral segment. Due to the increasing amount of information about the behavior of these hemangiomas, therapeutic decisions are diverse. Nevertheless, in the case of aggressive hemangiomas, definitive treatment protocols should focus on surgery and total excision of the lesions as a gold standard.

Ependymoma is the most common spinal cord tumor in the adult population, but it is, nevertheless, very rare. Most patients have no symptoms or only nonspecific symptoms. Intraspinal anesthesia is the preferred anesthetic technique for obstetric surgery because it has minimal effects on the fetus. Spinal anesthesia causing hemorrhage into spinal tumor have been reported, but very few have been for epidural anesthesia. We describe a case of a 36-year-old female patient who presented with acute paraplegia due to after undergoing a cesarean section under epidural anesthesia. Magnetic resonance imaging suggested the possibility of subdural intratumoral hemorrhage. An emergency laminectomy, at T12-to-L1 level, was performed 39 hours after the cesarean section to decompress the spinal cord. An ependymoma was diagnosed after examination of the pathological specimen. She received physical rehabilitation support after surgery. The patient was left with residual motor and sensory deficits finally. Early identification and early surgery minimize the risk of severe neurological deficit following acute spinal cord compression.

Abstract Introduction:An exceptionally rare but critical complication of hyperthyroidism is thyrotoxic periodic paralysis (TPP), which may serve as one of the first presentations of thyrotoxicosis. The disease manifests as acute flaccid muscle weakness, primarily affecting proximal muscles. Labwork will reveal significant hypokalemia with elevated thyroxine and triiodothyronine levels. Although this is an incredibly rare occurrence, it predominantly affects Asian males, with an incidence of 1.8%, compared to an 0.2% incidence in other populations. While the mechanism of disease is not well understood, it is thought that an acute intracellular shift of potassium serves as a trigger for paralysis secondary to thyroid hormone induced beta-adrenergic stimulation. This results in hypokalemia via increased activity of sodium-potassium ATPase. The main pillar of treatment is management of the underlying thyroid disorder with aggressive potassium repletion. Case presentation:A 30-year-old male with hypertension presented with bilateral upper and lower proximal muscle weakness which had progressively worsened over the past day to the point that the patient was unable to walk now. He was found to have undetectable TSH with elevated T3 of 7, T4 of 5.34, and low potassium of 1.5. TSI was found to be 11.50. He received a total of 120 mEq of potassium and was admitted to the ICU for further care, where he was started on propranolol, methimazole, and hydrocortisone. The US thyroid showed thyromegaly without any nodules. The patient's weakness improved by the following day and he left against medical advice. Discussion:TPP is a rare but dangerous complication seen in hyperthyroid patients. It is characterized by hypokalemia along with proximal symmetrical upper and lower limb weakness that may involve respiratory musculature if not identified and treated appropriately. TPP remains a challenging diagnosis to make due to its rarity in non-Asian populations and features that mimic other periodic paralysis such as Guillan-Barre, transverse myelitis, and acute spinal cord compression. Here, we highlight a case of undiagnosed Graves’ disease that presented as a rare complication without typical symptoms of Graves’ disease.

Spontaneous spinal epidural haematoma (SSEH) is a rare cause of acute spinal cord compression. This condition is often associated with use of anticoagulant drugs, coumarins or new oral anticoagulants, such as direct factor Xa inhibitor and direct thrombin inhibitor. The manifestation of severe neurological deficits is common and can lead to catastrophic consequences if not diagnosed early. Standard therapy is decompressive laminectomy, although spontaneous recoveries have been reported. Due to the rarity of this pathologic entity, only sporadic case reports and associated reviews are available. We report a case series of 4 patients diagnosed with spontaneous spinal epidural haematoma induced by new oral anticoagulants. Spontaneous spinal haematoma is a rare pathologic entity and therefore difficult to diagnose. For patients receiving long term anti-coagulant therapy, SSEH should be included in the differential diagnosis. Prompt surgical evacuation of the haematoma and haemostasis leads to favourable neurological outcome, whereas delay in treatment can be disastrous.

An acute spinal cord compression can very rarely cause a spinal epidural hematoma. The functional recovery will be the highest if early detection and prompt surgical management are undertaken. The conservative management was successful in the present case of the cervical epidural hematoma with lesser neurodeficits and smaller hematoma size with minimal cord compression. The patient had no neurodeficit at the end of 7 days.

Introduction: Spinal cord compression is a health problem. They represent a major cause of long-term disability. A spinal cord compression due to spondylodiscitis is an inflammatory aetiologie. Objective: to describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of acute spinal cord compression due to infectious spondylodiscitis. Population and Methods: this was a cross-sectional, descriptive study with retrospective collection extending from January 1st, 2018 to December 31th, 2023. It concerned all patients admitted to the neurosurgery department of CHUD-B/A, for acute spinal cord compression due to infectious spondylodiscitis. Results: A total of 31 patients were included in the study. Mean age was 28.35 ± 15.20 years, with extremes of 10 and 72 years. Male predominance, with a sex ratio of 1.58. Average admission delay of 5.74 ± 5.92 months, with spinal pain as the reason for admission in 51.61% of cases. Lesion syndrome present in 100% of cases, with paraparesis as a deficit in 51.61%, and Franckel Grade C in 67.74% of cases. Compressive epiduritis (54.84%) was the predominant lesion on CT scan with injection. C-reactive protein and sedimentation rate were disturbed in 38.71% and 25.81% of patients respectively. Of these, 77.42% of spondylodiscitis cases were of tuberculous etiology, with 100% treated with anti-tuberculosis drugs (ERHZ). Surgical treatment was performed in 22% of patients, with an average delay of 2.71 ± 2.36 days; 6 by anterior approach and 1 by posterior approach. The long-term evolution was favorable with 71.43% of complete neurological recovery at one year. No deaths were recorded in this study. Conclusion: The frequency of tuberculous spondylodiscitis is commonly high; surgical management in this serie is limited by the socioeconomic level of patients. But the outcome is good when surgical procedures are performed with no mortality.

Spontaneous Spinal Epidural Hematoma (SEH) is a rare cause of acute spinal cord compression, with an estimated incidence of 0.1 per 100,000 patients annually. This case report describes a 63-year-old male who presented with a 10-day history of severe lower back pain, right foot numbness, and right lower limb weakness, without any history of trauma or relevant comorbidities.

Background: Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges in terms of diagnosis, management, and prognosis. Metastatic lesions from cancer are a common cause of spinal cord compression, affecting a substantial portion of oncology patients, and only in the US has the percentage risen to 10%. Acute metastasis-correlated spinal cord compression poses a considerable clinical challenge, necessitating timely diagnosis and intervention to prevent neurological deficits. Clinical presentation is often non-specific, emphasizing the importance of thorough evaluation and appropriate differential diagnosis. Diagnostic workup involves various imaging modalities and laboratory studies to confirm the diagnosis and assess the extent of compression. Treatment strategies focus on pain management and preserving spinal cord function without significantly increasing patient life expectancy, while multidisciplinary approaches are often required for optimal outcomes. Prognosis depends on several factors, highlighting the importance of early intervention. We provide an up-to-date overview of acute spinal cord compression in metastases, accentuating the importance of comprehensive management strategies. Objectives: This paper extensively explores the pathophysiology, clinical presentation, diagnostic strategies, treatment modalities, and prognosis associated with spinal cord metastases. Materials and Methods: A systematic literature review was conducted in accordance with the PRISMA guidelines. Conclusions: We aim to help healthcare professionals make informed clinical decisions when treating patients with spinal cord metastases by synthesizing current evidence and clinical insights.

Spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of acute spinal cord compression. It is a neurological emergency that requires urgent imaging and appropriate treatment to prevent permanent neurological sequelae. Here, we present the case of a 30-year-old male with no known comorbidities who presented to the emergency department with a history of sudden onset of upper backache and chest discomfort followed by bilateral lower limb weakness. On examination, the blood pressure was 220/120 mmHg, and neurological examination showed decreased tone and power of 2/5 in bilateral lower limbs. In view of the initial chest discomfort, a cardiac evaluation was done, which was normal, followed by magnetic resonance imaging of the whole spine, which showed a lesion in the anterior epidural space suggestive of hematoma, causing spinal cord compression. A final diagnosis was C6-T2 dorsal SSEH secondary to a hypertensive emergency.

Spinal epidural hematomas (SEH) are a rare form of hematoma affecting the nervous axis. Spontaneous epidural hematomas are defined as the presence of blood in the epidural space without any known cause. They may be associated with coagulopathies or arteriovenous malformations. HSSE can lead to disabling neurological deficits. Imaging and rapid intervention should be initiated as soon as a patient presents with symptoms suggestive of HGSS. We report the case of a 36-year-old patient who presented with SEH in a setting of acute spinal cord compression.

Congenital lipomatous overgrowth, vascular malformations, epidermal nevi, spinal/skeletal anomalies, and/or scoliosis (CLOVES) syndrome is the most recently described combined vascular anomaly characterized by congenital excessive growth of adipose tissue, vascular malformations, epidermal nevi, and skeletal deformities. This condition exhibits a significant variability in clinical manifestations and a tendency for rapid progression and affects extensive anatomical regions. Information regarding the association of epidural lipomatosis with low-flow venous lymphatic malformations is rare, with few reports in the literature. The authors present a case of a 6-year-old girl who was admitted to the emergency department complaining of rapidly progressing weakness in her lower extremities and partial loss of sensation in the inguinal area. Radiologically, an extradural mass was identified at the T2-6 level, causing acute spinal cord compression. Urgent decompression and partial resection of the mass were performed. Despite satisfactory intraoperative hemo- and lymphostasis, postoperative lymphorrhea/seroma leakage was encountered as a delayed complication and was managed conservatively. CLOVES syndrome is characterized by the combination of various clinical symptoms, not all of which are included in the abbreviation, as well as a progressively deteriorating course, the emergence of new symptoms, and complications throughout the patient's life. This necessitates ongoing monitoring of such patients.

Traumatic spinal epidural hematoma (TSEH) is a rare condition that may cause acute spinal cord compression and lead to irreversible neurological impairment. TSEH not only compresses the cord, but it can also worsen cervical nerve root avulsion. To our knowledge, only five cases of combined TSEH and cervical nerve root avulsion have been reported in the literature. We present the case of a 42-year-old woman who suffered a motorcycle accident. On admission, she presented with mild traumatic brain injury and cervical spine and right shoulder trauma. A physical examination revealed numbness and flaccid paresis in her right arm, compromising the C5 to T1 dermatomes and myotomes. MRI images showed evidence of a right anterolateral spinal epidural hematoma (SEH) that extended from the C2 to C7 vertebral levels. MRI and electromyography findings of the presence of a pseudomeningocele from the C4-C5 to C7-T1 levels indicating brachial plexus neurotmesis supported the presence of a cervical nerve root avulsion associated with TSEH. Cervical plexus syndrome requires a comprehensive diagnostic workup. SEH should be considered a cause of nerve root avulsion and brachial plexus syndrome. We believe that the extension of SEH into the intervertebral foramina could be a radiological sign related to nerve root avulsion.

We report two cases of acute spinal cord compression in children with low-flow spinal epidural arteriovenous fistulas (SEAVFs) and discuss the clinical presentation and management of these vascular anomalies. While most low-flow SEAVFs without radiculomedullary drainage are benign lesions typically diagnosed incidentally, we suggest that asymptomatic lesions may warrant aggressive management in specific circumstances, including lesions diagnosed at an early age or in patients under anticoagulation therapy. Our observations also emphasize that patients with a "spontaneous" epidural hemorrhage should undergo dedicated preoperative or postoperative vascular imaging to identify a possible underlying vascular anomaly.

Abstract Malignant myeloid sarcoma (chloroma) is a rare extramedullary solid tumor that consists of immature myeloid precursor cells, constantly associated with acute myeloid leukemia (AML). Here, we report the case of a 35-year-old male who developed an acute paraplegia secondary to paraspinal chloroma associated with AML. A careful review of the patient’s history, blood smear, and bone marrow findings will decrease the chance of missing the diagnosis.

Vertebral bodies are one of the most common metastasis sites found in advanced prostate cancer and have a significant impact on patients' quality of life. Spinal metastases frequently cause severe back pain and in some occasions can lead to secondary complications, with serious neurological deficits and loss of function. The main treatment goals include adequate pain management, controlling tumour growth and restoring spinal stability. Publications on the role of surgery - both conventional and stereotactic radiotherapy, and either as an individual modality or in combination - have been inconclusive. The NOMS score has proven to be useful in making treatment decisions. Existing data show better outcomes in patients with surgical therapy, both when performed in isolation and also combined with radiotherapy, in which some of the cohorts studied including patients with primary cancer other than prostate cancer. Comparative studies that specifically investigate the superiority of specific therapy modalities for metastatic prostate carcinoma are scarce. Similarly, there are limited data on microsurgical interventions for spinal metastases. Radiotherapy alone is crucial in the setting of palliation, especially for pain relief, and its effectiveness has been shown in many studies. The patient's life expectancy plays a crucial role in deciding the most appropriate treatment approach. Given the complexity of the patient population, a multimodal therapy approach is necessary. Current trends in therapy favour greater use of surgical interventions, particularly in the early detection of spinal metastases.

Systematic review and meta-analysis. To perform a systematic review of the clinical symptoms, radiographic findings, and outcomes after spinal decompression in B-cell lymphoma. B-cell lymphoma is a potential cause of spinal cord compression that presents ambiguously with nonspecific symptoms and variable imaging findings. Surgical decompression is a mainstay for both diagnosis and management, especially in patients with acute neurological deficits; however, the efficacy of surgical intervention compared with nonoperative management is still unclear. The databases of Medline, PubMed, and the Cochrane Database of Systemic Reviews were queried for all articles reporting spinal B-cell lymphoma. Data on presenting symptoms, treatments, survival outcomes, and histologic markers were extracted. Using the R software "survival" package, we generated bivariate and multivariate Cox survival regression models and Kaplan-Meier curves. In total, 65 studies were included with 72 patients diagnosed with spinal B-cell lymphoma. The mean age was 56.22 (interquartile range: 45.00-70.25) with 68% of patients being males and 4.2% of patients being immunocompromised. Back pain was the most common symptom (74%), whereas B symptoms and cauda equina symptoms were present in 6% and 29%, respectively. The average duration of symptoms before presentation was 3.81 months (interquartile range: 0.45-3.25). The most common location was the thoracic spine (53%), with most lesions being hyperintense (28%) on T2 magnetic resonance imaging. Surgical resection was performed in 83% of patients. Symptoms improved in 91% of patients after surgery and in 80% of patients treated nonoperatively. For all 72 patients, the overall survival at 1 and 5 years was 85% (95% CI: 0.749-0.953; n = 72) and 66% (95% CI: 0.512-0.847; n = 72), respectively. Although surgery is usually offered in patients with acute spinal cord compression from B-cell lymphoma, chemotherapy and radiation alone offer a hopeful alternative to achieve symptomatic relief, particularly in patients who are unable to undergo surgery.

196. Rapid MRI protocol for acute spinal cord trauma and cord compression