Brain Tumor Res Treat.  2016 Apr;4(1):30-34. 10.14791/btrt.2016.4.1.30.

Acute Paraplegia as a Result of Hemorrhagic Spinal Ependymoma Masked by Spinal Anesthesia: Case Report and Review of Literature

• Lee SH
• Park DJ
• Jeun SS

• KMID: 2165232
• DOI: http://doi.org/10.14791/btrt.2016.4.1.30

Abstract

Ependymomas are the most common intramedullary spinal cord tumors in adults. Although a hemorrhage within spinal ependymoma on imaging studies is not uncommon, it has rarely been reported to bea cause of acute neurological deficit. In the present report, we describe a case of a 24-year-old female patient who developed acute paraplegia as a result of hemorrhagic spinal ependymoma immediately after a cesarean delivery under spinal regional anesthesia. We review the literature of hemorrhagic spinal ependymomas presenting with acute neurological deficit and discuss the most appropriate treatment for a good neurological recovery.

Keyword

Ependymoma; Spinal cord neoplasms; Paraplegia; Hemorrhage; Delivery

MeSH Terms

Adult
Anesthesia, Conduction
Anesthesia, Spinal*
Ependymoma*
Female
Hemorrhage
Humans
Masks*
Paraplegia*
Spinal Cord Neoplasms
Young Adult

Figure

• 

  Fig. 1 Initial spinal magnetic resonance image (MRI) scan. A: T2-weighted MRI shows an abnormal spinal cord lesion from C2 level to D5. A spinal cord swelling with an irregular high signal intensity is noted in T2-weighted image. The margin is poorly demarcated. Most part of the lesion is suspicious of a syrinx formation or a hemorrhage. B: The lesion shows the low signal intensity in T1-weighted MRI. C: Gadolinium-enhanced T1-weighted MRI shows a heterogeneously enhancing lesion from C6 to D2. There is no abnormal intradural lesion in the proximal and distal areas.

• 

  Fig. 2 Preoperative spinal MRI scan after 2 weeks of medical treatment. A: Preoperative gadolinium-enhanced T1-weighted MRI shows a heterogeneously enhancing mass from C3 level to D2 level. B: Axial cut of gadolinium-enhanced T1-weighted MRI shows a dark central portion with the margin enhancement.

• 

  Fig. 3 Intraoperative findings. A: Unilateral hemilaminectomies were performed on the left side of C7 and T1 level. B: After opening the dura, a midline incision was done precisely at the spinal cord. A gray and sticky mass was observed below the midline pial incision (arrow). C: After removing the mass partially, a dark hematoma was observed inside the mass (arrow) and a large amount of the dark hematoma could be sucked out easily.

• 

  Fig. 4 Postoperative spinal MRI scan. A huge amount of the abnormal lesion decreased. A: T2-weighted MRI shows a hyper-intense lesion from C4 level to D2 level. B: T1-weighted MRI shows the same lesion in the low signal intensity. C: Enhancing portion is much more decreased in gadolinium-enhanced T1-weighted MRI as compared to the preoperative MRI scan. The remaining lesion is mainly from C7 to D2 level.

• 

  Fig. 5 Spinal MRI scan taken 1 week after the first surgery (preoperative MRI for the second surgery). A: Gadolinium-enhanced T1-weighted MRI shows that the enhancing mass diminished significantly and was partially removed at T1 level. B: Axial image of gadolinium-enhanced T1-weighted MRI shows a dark central portion which was the hematoma totally removed and the nhancing portion remained.

• 

  Fig. 6 Postoperative spinal MRI scan after the second surgery. A: Gadolinium-enhanced T1-weighted MRI shows that most of the enhancing portion was removed and only a very thin-layered enhancing portion remained. B: Axial image of gadolinium-enhanced T1-weighted MRI shows a thin-layered enhancing portion remaining at C7 level.

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