Magnetic resonance imaging of syringomyelia associated with an extramedullary spinal cord tumor: case report

The association of syringomyelia and extramedullary spinal cord tumors is rare. We present the case of a patient with this association documented by magnetic resonance imaging and discuss the unusual features of the syrinx.     

脊髓内肿瘤伴全长空洞的诊治体会

目的探讨髓内肿瘤伴脊髓全长空洞的诊断、治疗方法及空洞形成机制.方法对6例确诊为髓内肿瘤伴脊髓全长空洞的患者行显微镜下肿瘤摘除术,空洞不予处理.结果经3年的随访,6例均疗效明显,肿瘤摘除完整,空洞自行缩小或消失,症状改善.病程越短,疗效越好.结论脊髓全长空洞发生率可能比文献报道高.空洞是由于肿瘤本身的梗阻引起,显微外科技术能最大限度地保留脊髓功能,空洞不需处理.     

Metastatic intradural extramedullary spinal cord tumor from ovarian cancer: A case report with a literature review

Context: Metastatic intradural extramedullary spinal cord tumors are extremely rare.Findings: A 76-year-old woman presented with intractable neck pain. Three years earlier, she had been treated for ovarian cancer with bilateral salpingo-oophorectomy. A year later, she underwent resection of a brain metastasis. Magnetic resonance imaging (MRI) showed an encapsulated intradural extramedullary mass at C4–C5. C4–C5 hemilaminectomy, tumor resection, and biopsy were performed. Histological examination of the resection revealed an adenocarcinoma. After surgery, her intolerable neck-shoulder pain was fully resolved, and she had no difficulties with daily living activities. However, two months later, she underwent gamma knife radiosurgery for the recurrent metastatic brain tumor, and four months later, she died from cachexia.Conclusion: Although cases of metastatic intradural extramedullary spinal tumors from ovarian cancer are extremely rare, their possibility should be considered in the differential diagnosis. A history of brain metastases and enhancement on T1-weighted MRI were helpful for making an accurate diagnosis.     

Syringosubarachnoid shunt for noncommunicating syringomyelia associated with spinal lipoma: a case report

Noncommunicating syringomyelia may complicate repeated untethering procedures in patients with spinal lipomas. Surgical intervention is indicated when syringomyelia is symptomatic. However, the preferred surgical procedure for noncommunicating syringomyelia associated with spinal lipomas has not been established. The authors report a case of noncommunicating syringomyelia associated with a spinal lipoma which was successfully treated with a syringosubarachnoid (S-S) shunt. The patient was a 9-year-old girl with a past history of an excision of a dermal sinus at the age of three months and an untethering of the spinal cord at the age of five. She developed a gait disturbance in the year prior to surgery, and a magnetic resonance imaging (MRI) study demonstrated syringomyelia from the second thoracic vertebra to the fourth lumbar vertebra. S-S shunt surgery successfully addressed the syringomyelia without adverse events, and a follow-up MRI study showed reduction of the size of the lesion. S-S shunt placement was therefore considered to be an effective treatment option for noncommunicating syringomyelia associated with a spinal lipoma.     

椎管内髓外硬膜下黑色素性神经鞘瘤1例报告

<正>黑色素性神经鞘瘤(melanotic schwannoma,MS)临床罕见,仅占所有黑色素瘤的1%,多数为良性或潜在恶性,青壮年多见,好发于脊神经后根和交感神经节,我们收治1例胸椎髓外硬膜下黑色素性神经鞘瘤,手术治疗效果满意,报告如下。患者男,47岁。胸背部疼痛1年,双下肢麻木无力20d,加重伴大小便潴留4d于2012年1月3日入院。患者1年前出现胸背部疼痛,以胆囊炎治疗,胸背部疼痛略有     

Intramedullary spinal cord metastasis associated with hemorrhage: a case report

A rare case of intramedullary spinal cord metastasis associated with hemorrhage was reported. A 74-year-old man had a subacute onset of paraparesis. He became almost paraplegic within a few days. MRI revealed an intramedullary spinal lesion in the epiconus at the Th 11 and Th 12 level, but spinal angiography did not show any abnormality. Since repeated MRI showed enlargement of the lesion, surgery was performed under the diagnosis of an intramedullary spinal cord tumor. Under general anesthesia, a midline myelotomy of about 3 cm was performed and a grayish, elastic and circumscribed tumor as well as a liquefied hematoma in the caudal part was observed. Both the tumor and the hematoma were removed almost totally. The patient's paraparesis improved slightly after surgery. The histological diagnosis was adenocarcinoma. The primary source was unknown, but multiple small metastatic tumors were found in the lung, liver and brain, etc. Hemorrhage from intramedullary spinal cord metastasis is extremely rare with only 6 reported cases in the recent literature. Rapid deterioration of symptoms caused by the hematoma may make the diagnosis more difficult. Indication of surgical treatment should be carefully determined because prognosis of intramedullary spinal cord metastasis is generally very poor.     

Cordectomy for syringobulbo-myelia with sleep apnea secondary to a spinal extramedullary tumor: case report

The case of a 40-year-old man with syringobulbo-myelia secondary to an unresectable spinal extramedullary tumor is described. Fifteen years previously, the patient had undergone a laminectomy of T8 through T12 for a "benign" spinal cord tumor at another hospital and had become paraplegic; the tumor (neurinoma) had been neglected for 12 years. Magnetic resonance imaging demonstrated a large thoracolumbar spinal tumor with syringobulbo-myelia. Polysomnography showed central-, peripheral-, and mixed-type sleep apneas. After the failure of an attempted syringoperitoneal shunt, cordectomy at the level of T6 was performed with a good result. The mechanisms of the formation of syringomyelia and sleep apnea secondary to a caudal spinal extramedullary tumor are discussed.     

Intramedullary abscess associated with a spinal cord ependymoma: case report.

Intramedullary spinal cord abscesses are relatively uncommon. We report the first case of an intramedullary spinal cord abscess in a preexisting spinal cord ependymoma. The clinical features and pathogenesis are discussed. Salient features of the management of intramedullary spinal cord abscesses are outlined.     

Disseminated intravascular coagulation associated with spinal cord laceration: a case report

A 31-year-old man was thrown from his motorcycle, sustaining a thoracolumbar fracture and cervical spine fracture with no evidence of neurologic function below L1. At the time of spinal fusion, there was diffuse bleeding from the soft tissues. Visualization of the thoracolumbar fraction revealed separation of the laminae with a dural tear and extruding spinal cord tissue. Laboratory evaluation identified abnormal clotting studies intraoperatively and postoperatively. We postulate that release of potent spinal cord thromboplastins into the systemic circulation may elicit a coagulopathy, as has been recognized following craniocerebral trauma.     

Charcot shoulder joint associated with syringomyelia: a case report

A 36-year-old man with degenerative disease of the spine and cervical syringomyelia (syrinx) presented with new weakness and numbness in his left upper extremity. Examination revealed decreased range of motion (ROM), swelling, weakness, and diminished pinprick, vibratory, and proprioceptive sensation in the left upper extremity. Radiographic examination showed a severe destructive arthropathy; a biopsy ruled out malignancy. A culture was negative for infection, and a repeat magnetic resonance imaging (MRI) showed a patent syringo-peritoneal shunt with no change in syrinx size. He was diagnosed with a Charcot shoulder. Treatment consisted of nonsteroidal anti-inflammatory medication, passive motion exercises, and a protective sling. The patient with syringomyelia may experience sensory loss that prevents normal guarding, resulting in repetitive trauma and eventual joint destruction. Appropriate assessment, diagnostic work-up, and treatment are essential in the management of the Charcot joint. Patient education, including information on activities that may be harmful, must be included, as such knowledge may slow or prevent the impairment that comes with a Charcot joint.     

原发性脊髓内黑色素瘤并脊髓空洞症1例

原发于椎管内的黑色素瘤十分罕见,自1906年首次发现以来,国内外均只见散在报道。有学者认为此病多发于中下段胸椎,而部位在髓内的较髓外硬膜下较少[1]。我院于2014年收治1例,现报道如下。     

Posttraumatic syringomyelia developing soon after spinal cord injury. A case report

We report a case of posttraumatic syringomyelia (PTS) that developed 10 months after spinal cord injury (SCI), A 46-year-old man was involved in a motorcycle accident, in which he received a severe spinal cord injury due to a burst fracture at the T6 level. The patient underwent posterior fixation without decompression at another hospital, and was transferred to our hospital for rehabilitation. Ten months after the SCI, he complained of back and neck pain caused by bending his head backward. MRI showed syringomyelia shaped like a cone extending from the T6 to the C6 level, enlarged by cerebrospinal fluid (CSF) flow toward the syringomyelia at the T6 level. Pain was relieved by syringosubarachnoid shunt implantation and the syrinx disappeared after the operation. PTS emerging 10 months after spinal cord injury is relatively rare. From the radiological and operative findings, PTS was enlarged by the CSF flow, which was hindered at the T6 level by compression of the vertebral body to the spinal cord. In cases of SCI in patients who undergo posterior fixation with insufficient decompression, close attention to PTS is required in the postoperative follow-up.     

地中海贫血合并胸椎椎旁及椎管内髓外造血压迫脊髓1例报道

<正>髓外造血(extramedullary hematopoiesis,EMH)系良性病变。原发病多为地中海贫血、镰状细胞贫血、遗传性球形红细胞增多症等^[1、2]。EMH常被认为是此类疾病的一个特征性表现。EMH组织增生部位主要见于肝、脾、淋巴结^[2、3]。EMH常无典型的临床症状,如发生在椎管内易出现脊髓压迫症状,而发生于椎管内压迫脊髓造成瘫痪的病例极少见。我院收治1例地中海贫血合并胸椎椎旁及椎管内EMH压迫脊髓的病例,报告如下。     

脊髓髓内孤立性纤维性肿瘤1例报道

正孤立性纤维性肿瘤(solitary fibrous tumors,SFT)是一种临床罕见的来源于间叶组织的梭形细胞肿瘤,1931年Klemperer和Rabin首次将其描述为一种来源于间叶细胞的纤维增殖性肿瘤~([1])。其主要发生在脏层胸膜,也可发生在全身各处~([2、3])。多数表现为良性,一般无明显临床症状~([4])。近期我院收治了1例脊髓髓内SFT,报告如下。患者女,62岁,因"左下肢无力11月余"于2016年     

Cervical spondylotic myelopathy associated with syringomyelia: A case report

Summary A case of syringomyelia associated with cervical spondylotic myelopathy is presented. A decompressive cervical laminectomy was performed. The patient improved gradually after operation. It is concluded that the choice of surgical treatment in cases with syringomyelia associated with cervical spondylotic myelopathy requires a careful neurological and radiological examination based on the findings of magnetic resonance imaging (MRI) and cine-MRI.     

Infarct of the conus medullaris simulating a spinal cord tumor: case report

A 71-year-old woman had the sudden onset of a neurogenic bladder and a stepwise increase in paraparesis that left her unable to stand or walk. Magnetic resonance imaging showed what appeared to be a tumor in the conus medullaris. After laminectomy, the lesion was localized by ultrasound examination, and a biopsy was performed. The deficits remained unchanged postoperatively. Microscopic examination of the biopsy specimen showed necrosis and pathologic changes consistent with infarction of the conus medullaris. An anomalous arterial supply of the conus medullaris is the most likely cause of this unusual problem. The patient gradually regained her ability to walk, but the neurogenic bladder persists.