Anesth Pain Med.  2022 Oct;17(4):439-444. 10.17085/apm.22128.

Spinal intramedullary cavernous angioma patient in a pain clinic - A case report -

• Kim SB
• Cho SB
• Lim S

• KMID: 2535344
• DOI: http://doi.org/10.17085/apm.22128

Abstract

Background
Spinal intramedullary cavernous angioma is a rare form of spinal cord tumor that is associated with myelopathy and significant morbidity and surgical treatment is almost always required. Case: We report a case of spinal intramedullary cavernous angioma in a pain clinic with initial symptoms of unilateral interdigital space sensory change. Morton’s neuroma and piriformis syndrome were clinically suspected, however, symptoms acutely aggravated, and paraplegia developed following the patient’s COVID-19 vaccination. Vaccine-associated side effects were ruled out and spinal intramedullary cavernous angioma was confirmed through magnetic resonance image. The patient underwent surgery for complete mass excision.
Conclusions
Recent reports of COVID-19 vaccine-associated side effects have raised sensitive concerns to both health care providers and the public, that in some cases when the symptoms coincide with vaccination history, it may delay time-sensitive diagnosis and treatment and spend unnecessary costs.

Keyword

Cavernoma; Cavernous angioma; COVID-19 vaccination; Myelopathy; Spinal cord tumor

Figure

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  Fig. 1. Lumbar T2 weighted image. Taken when pain in his right hip and numbness in the back of his thigh appeared. There are no specific findings except degenerative changes.

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  Fig. 2. Lower extremity computed tomography angiogram. Taken at emergency room visit with sudden loss of sensation and paralysis in the entire right leg and electricity-like pain. There are no findings suggestive of arterial occlusion, such as thromboembolism.

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  Fig. 3. Thoracic T2 weighted image. At the T10 level, intramedullary carvernous angioma was observed. Since hemosiderin deposition is observed in two layers, it is estimated that there will be at least two bleeding.

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  Fig. 4. Two layers of hemosiderin deposition. Hyperintense lesions with different intensities are shown as two layers, with a black dotted line A and a white dotted line B.

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