Spinal epidural haematoma: report of 11 cases and review of the literature

Spinal epidural haematomas (SEH) are rare; most are caused by trauma, anticoagulant therapy, vascular anomalies, hypertension, blood dyscrasias, epidural anaesthesia or, rarely, spinal surgery. We report 11 cases and review the literature (16 cases). The clinical picture is that of acute spinal cord compression. MRI characteristics are quite specific. On sagittal sections, the SEH appears as a biconvex mass, dorsal to the thecal sac, clearly outlined and with tapering superior and inferior margins. The dura mater is seen as curvilinear low signal separating the haematoma from the cord. Within 24 h of onset, the haematoma is isointense with the cord on T1-weighted images and heterogeneous on T2-weighted images. Later, it gives high signal on both T1- and T2-weighted images. Differential diagnosis must include subdural haematoma, epidural neoplasm and abscess. Complete neurological recovery rapidly follows laminectomy and removal of the clot. In three of our cases, the haematoma resolved spontaneously. MRI is the best examination for diagnostic and follow-up.     

Spinal epidural lipomatosis. Case report and review of the literature

Spinal epidural lipomatosis (SEL) is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It is most frequently seen in patients on chronic glucocorticosteroid therapy for a variety of medical problems. This is a case report of lumbar epidural lipomatosis in a bodybuilder with radiculopathy supposedly induced by anabolic steroid intake.     

Epidural lipomatosis: case report and literature review

We report a case of symptomatic epidural lipomatosis in a 36-year-old man following a heart lung transplant and 3.5 years of steroid medication. A review of the pertinent literature emphasises the importance of including this diagnosis in the differential diagnosis of patients receiving steroid medication or markedly obese patients with back pain or symptoms suggesting spinal cord or cauda equina compression.     

Radiological and histological findings in spinal intramedullary angiolipoma

We report an intramedullary angiolipoma with spinal cord compression studied by MRI, angiography and CT. Angiolipomas of the spine are rare benign tumours containing vascular and mature adipose elements. They are epidural in more than 90 % of the cases; only three cases of intramedullary angiolipoma are described. The clinical picture is nonspecific, but MRI and CT suggest the diagnosis. Accepted: 16 December 1998     

Intracranial angiolipoma as cause of subarachnoid haemorrhage. Case report and review of the literature

A 33-year-old female with a longstanding history of seizures was admitted to our hospital with subarachnoid haemorrhage (SAH). Computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) depicted a vascular fat-containing lesion overlying a right frontal cortical polymicrogyria. The diagnosis of angiolipoma was established. Conservatory management was undertaken with full recovery. She has been followed for 5 years since, with neither re-bleeding nor morphologic change of the lesion. This is a rare intracranial lesion, with only 11 intracranial angiolipomas published in the literature, and is the first case reported which is associated with SAH caused by this lesion.     

MRI of intramedullary spinal schwannomas: case report and review of the literature

Intramedullary spinal schwannomas are uncommon. We report a solitary cervical intramedullary schwannoma shown by MRI and treated surgically, and review 12 previous cases with MRI. MRI findings and pathogenesis are discussed. Received: 22 March 1999 Accepted: 2 August 1999     

胸椎嗜酸性肉芽肿1例及文献复习

目的结合脊柱嗜酸性肉芽肿的影像表现,加强对脊柱椎体破坏性疾病的鉴别诊断能力。方法分析1例胸椎嗜酸性肉芽肿病人的CT及MRI表现,同时就脊柱椎体破坏伴周围软组织影的影像诊断文献予以复习。结果 CT示T7椎体呈楔形,其内可见溶骨性骨质破坏,T6、T8椎体前缘局部皮质不规则,可见骨质破坏;周围软组织呈明显梭形增厚;诸椎间盘信号正常,椎间隙未见变窄。MRI平扫示T7椎体呈楔形,T1WI呈低信号,T2WI呈稍高信号,T2WI抑脂序列呈高信号,周围可见软组织影包绕;T6、T8椎体于T2WI抑脂序列上信号略增高。MRI增强示T7椎体呈均匀强化;周围软组织影呈均匀强化,强化方式与病变椎体一致。手术后病理学检查结果符合骨的朗格汉斯细胞增生症。结论脊柱嗜酸性肉芽肿椎体破坏多位于椎体中部,典型表现为"扁平椎"或"铜板椎",椎间盘不受累,增强扫描椎旁软组织明显强化,信号改变及强化方式与病变椎体一致等影像特点是鉴别诊断的关键。     

Inflammatory myofibroblastic tumour of the spinal cord: case report and review of the literature

Inflammatory myofibroblastic tumours (IMT), also called inflammatory pseudotumours, nodular lymphoid hyperplasia, plasma-cell granuloma and fibrous xanthoma, are rare soft-tissue lesions characterised by inflammatory cells and a fibrous stroma. Clinically and radiologically, they may look like malignant tumours. They rarely affect the central nervous system and are very rare in the spinal cord. We report an IMT of the spinal cord in a 22-year-old woman presenting with spinal cord compression and a cauda equina syndrome. MRI showed a lesion at T9 with extramedullary and intramedullary components giving low signal on T2-weighted images and enhancing homogeneously. Pial lesions on the lumbar enlargement and thoracic spinal were present 11 months after surgery, when the lesion recurred. We present the radiological, operative and pathological findings and review the literature.     

Evaluation of clinical and MR findings for the prognosis of spinal epidural haematomas

AIM: The potential of MR and clinical findings of spinal epidural haematomas (SEHs), particularly the early MR findings, to help minimize delays in diagnosis, to aid prognosis and as a reference for conservative treatment, are evaluated. METHODS: Retrospectively 20 patients with SEHs (14 men and 6 women) were examined to record their neurological deficit, MR findings, management, clinical outcome, and interval between symptom onset and MRI or surgery. Two-tailed Fisher's exact test was used for these analyses. RESULTS: Of 8 patients with severe neurological deficit at the onset of symptoms, none had obvious clinical improvement after either surgical or conservative management. Of 12 patients with mild to moderate deficits, 11 (92%) showed improvement or recovery of clinical symptoms. T2-weighted images revealed myelopathy or infarction of the compressed spinal cord in 9 patients, 7 (78%) of whom had no improvement in neurological deficit with either conservative or surgical management. Images in 6 patients showed contrast enhancement in the haematomas. CONCLUSION: Poor clinical outcomes were observed mainly in those with severe neurological deficit and hyperintensity on T2-weighted images of the involved spinal cord. Surgery did not appear to improve outcome in many of these patients. In acute SEHs, MRI showed characteristic findings, such as contrast enhancement, which should not be confused with signs of inflammatory or neoplastic epidural disease.     

Double spinal dural arteriovenous fistulas: case report and review of the literature

Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation. It mainly affects men after the fifth decade and is usually an acquired lesion with an unknown etiology. We report on a patient with the unusual finding of two separate SDAVFs at the level of L1 on the right and L2 on the left side. Initial selective spinal digital subtraction angiography (DSA) was terminated with demonstration of a SDAVF at the level of L1 but incomplete demonstration of all segmental arteries. Due to a recurrent deterioration of the patients neurological status, and persistent pathological vessels seen on MRI, a second spinal DSA was performed 6 years later, demonstrating the second fistula at the level of L2 on the left side with a separate venous drainage pattern. A retrospective analysis of the angiographic films suggested that both fistulas had already been present 6 years previously. This conclusion is justified because of a transient and faint opacification of the left L2 fistula demonstrated on the films after injection of the right L2 segmental artery. We conclude that in the case of incomplete angiography and persistent clinical and MR findings not only reopening of the treated SDAVF has to be taken into account but also the existence of a second fistula. Since this is the first case of a double fistula in our series of 129 SDAVFs, and given the few reported cases of double SDAVFs, we do not think that completion of selective spinal DSA has to be postulated routinely after a fistula has been found. However, repeat angiography should be performed in patients who continue to deteriorate, fail to improve with persisting MRI pathologies, or demonstrate delayed deterioration after a period of improvement.     

Spinal cord injury without radiographic abnormalities in children and adolescents: case report of a severe cervical spine lesion and review of literature

The biomechanics of the child’s and juvenile’s spine is responsible for the commonly encountered closed spinal trauma with significant neurological injury but without bony or ligament injury (particularly of the cervical spine). The ¶ligamentous laxity and hypermobility of the young bony cervical and thoracic spine predispose to spinal cord injury without radiographic abnormalities. We report a 16-year-old ¶girl with typical features of this type of injury after a “flic-flac” sports ¶injury. We conclude that children ¶and adolescents who have neurological deficits without positive radiographic findings require appropriate diagnostic screening, monitoring, and often a prolonged therapy. ¶The sometimes changing neurological deficits should never be ¶ignored or dismissed as psychogenic affection.     

Thoracic neurilemmoma: case report and review of the world literature

Thoracic tumors are unusual and tend to occur in the posterior mediastinum. A case of anterior thoracic neurilemmoma is presented, with plain film, computed tomographic, and pathologic correlation. Diagnosis of chest wall masses, including the role of computed tomography, is discussed, along with the significance of calcification in these lesions.     

颅内硬膜外软组织巨细胞瘤1例并文献复习

目的探讨软组织巨细胞瘤(GCT-ST)的影像特点及鉴别诊断。方法回顾性分析1例经手术病理证实的颅内硬膜外GCT-ST的平扫CT、平扫和增强MRI表现并行文献复习。结果颅底CT平扫显示左侧颞部多囊性低密度影,呈分叶状,内部见高密度分隔,邻近左侧颞骨局部骨质变薄、毛糙。MRI显示左侧颞部囊性肿物,T1WI呈低信号,T2WI呈高信号,T2 FLAIR呈等信号,其内见低信号分隔;增强检查可见病变边缘及分隔强化。结论颅内硬膜外GCT-ST罕见,其临床和影像表现无特异性,确诊需病理组织学检查。     

A case report of bladder paraganglioma and literature review

Bladder paraganglioma is a rare tumor originated from the chromaffin cells of the bladder. We discuss a case of a 49-year-old male patient with bladder paraganglioma, including the clinical and ultrasonographic features, the histopathological and immunohistochemical manifestations, the treatment and prognosis, and the differential diagnosis of this disease. The combination of ultrasonic examination and clinical manifestations may help to make the accurate diagnosis of bladder paraganglioma, and pathological examination should be used to confirm the diagnosis.     

Spinal cord herniation: report of two cases and review of the literature

Idiopathic herniation of the spinal cord is an extremely rare disorder which may cause progressive myelopathy. Two cases of this entity reported herein were both examined using MRI and CT myelography. The typical appearance of this disease with or without a dorsal intradural arachnoid cyst is focal ventral displacement of the mid-thoracic spinal cord, mimicking an isolated intradural spinal arachnoid cyst on MRI. CT myelography using thin slice sections is useful in the diagnosis of this disease. Received 14 August 1995; Revision received 30 January 1996; Accepted 4 June 1996     

Hypervascular vestibular schwannoma: A case report and review of the literature

Vestibular schwannomas, also known as acoustic neuromas, are benign tumors that arise from Schwann cells near the transition from glial cells to Schwann cells. While most vestibular schwannomas are hypovascular tumors, a small percentage constitute the hemorrhagic and/or hypervascular vestibular schwannomas (HVS) subtype. We describe a case of a 36-year-old female who presented with nausea, vomiting, and an acute decrease in vision in her right eye. Computed tomography of the head demonstrated a hemorrhagic lesion in the right hemisphere with evidence of ventricular effacement. Follow-up magnetic resonance imaging revealed a mass in the right cerebellopontine angle that was hypointense on T1-weighted imaging and mild hyperintense heterogeneous signal on T2-weighted imaging, suggestive of a hemorrhagic vestibular schwannoma. It is important for radiologists to recognize the unique clinical and radiological features of HVS in the initial diagnostic assessment of cerebellopontine angle tumors and to distinguish it from common (hypovascular) vestibular schwannomas and other related pathologies. A preoperative diagnosis of HVS allows clinicians to become familiar with the unique characteristics of the tumor and to devise a feasible operative strategy prior to surgical resection.     

结节性筋膜炎的影像学表现与病理所见(附1例报告并文献复习)

目的 提高对结节性筋膜炎的影像学表现及其与组织病理学相关性的认识。方法 报告1例经病理证实的结节性筋膜炎病例，并结合文献分析其X线，CT，MRI表现及其与病理学的相关性。结果 本例发生于上臂下段之深层肌间筋膜。X线显示肱骨下段外后缘不规则骨皮质缺损。XT除显示骨质改变外，还可见与周围组织密度相同的软组织肿块MRI显示TtWl上病变周边区呈稍高于肌肉信号、中央区不均匀低信号；TtWl病变周边稍高信号、中央区均匀高信号(明显高于脂肪信号)：病理所见符合黏液和细胞混合型筋膜炎。结论 本病为一良性病变，其MRI表现与组织病理学有相关性。应与纤维性骨皮质缺损、纤维肉瘤、恶性纤维组织细胞瘤、及韧带样纤维瘤相鉴别，     

Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2–L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. Received: 23 August 1999; Revised: 13 January 2000; Accepted: 4 February 2000