76
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Natale M, Spennato P, Savarese L, Bocchetti A, Esposito S, Barbato R. Anaplastic oligodendroglioma presenting with drop metastases in the cauda equina. Clin Neurol Neurosurg 2005; 107:417-20. [PMID: 16023538 DOI: 10.1016/j.clineuro.2004.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2004] [Revised: 09/03/2004] [Accepted: 09/07/2004] [Indexed: 11/25/2022]
Abstract
Metastatic involvement of the cerebro-spinal fluid (CSF) pathway in oligodendrogliomas is not uncommon; however, symptomatic involvement of the spinal cord is very rare: less of 10 cases have been published. To our knowledge, an intracranial oligodendroglioma presenting with symptoms of drop metastases in the cauda equina has never been reported. We report a case of 67-year-old woman who after 1 month of severe low back and legs pain developed symptoms of raised intracranial pressure. A spinal cord MRI showed multiple intradural nodular lesions at the level of the cauda equina, a MRI of the brain showed an intraventricular brain tumor. The histopathological diagnosis of both surgically treated lesions was anaplastic oligodendroglioma. The choices adopted in planning diagnostic and therapeutical procedures are discussed. The importance of the clinical and neuroradiological data in the diagnosis is stressed. Pathophysiology of the seeding of intracranial tumours via the cerebrospinal fluid is reviewed.
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77
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Ronen J, Goldin D, Itzkovich M, Bluvshtein V, Gelernter I, Livshitz A, Folman Y, Catz A. Outcomes in patients admitted for rehabilitation with spinal cord or cauda equina lesions following degenerative spinal stenosis. Disabil Rehabil 2005; 27:611-6. [PMID: 16019871 DOI: 10.1080/09638280400020649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate outcome measures and the factors affecting them in patients treated between 1,962 and 2,000 at Loewenstein Rehabilitation Hospital, Israel. METHOD This retrospective cohort study included 262 patients with spinal neurological lesions (spinal cord or cauda equina lesions) following degenerative spinal stenosis. Data were collected retrospectively. Survival was assessed using the Kaplan-Meier method and the relative mortality risk by the Cox model. Neurological recovery was evaluated by the change in Frankel grades, and factors that affect it were assessed by logistic regression. Associations of length of stay in rehabilitation were analyzed with ANOVA. RESULTS Median age at lesion onset was 61 years and median survival 17.6 years. Age at spinal neurological lesion onset was found to be the only factor with a significant effect on survival. Of the 148 patients who had Frankel grades A, B, or C on admission, 58% achieved recovery to grades D and E. Frankel grade at admission, age, and spinal neurological level had a significant effect on recovery. The mean length of stay was 99.7 days, and only Frankel grade had a significant effect on length of stay. CONCLUSIONS Patients with spinal stenosis and disabling spinal neurological lesions can achieve significant neurological recovery and survive for many years. They require adequate care in a specialist rehabilitation system.
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Abstract
This study presents a rare case of compound paraganglioma/ganglioneuroma with comprehensive immunohistochemical studies that reveal strong cytokeratin expression in all components. A 74-year-old woman presented with a mass lesion of the cauda equina. The 1.8-cm tumor showed 3 histomorphologically and immunohistochemically distinct components: typical paragangliomatous neuroendocrine areas, mature ganglion cell-like neuronal areas, and a "neuromatous" proliferation of Schwann cells with admixed axons. As often seen in cauda equina paragangliomas, the neuroendocrine cells were cytokeratin-positive. In addition, immunoreactivity for cytokeratins was also observed in the neurons and axons. This tumor illustrates the broad spectrum of divergent differentiation that can be seen in cells of sympathoadrenal lineage.
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79
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Walsh JC, O'Brien DF, Kumar R, Rawluk D. Paraganglioma of the cauda equina: A case report and literature review. Surgeon 2005; 3:113-6. [PMID: 15861947 DOI: 10.1016/s1479-666x(05)80072-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 26-year-old man presented with left leg pain and progressive paraparesis. Imaging revealed a large intradural tumour compressing the cauda equina. The lesion was radically resected and histological analysis revealed it to be a paraganglioma. The clinical features of this rare tumour are described with a review of the literature.
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80
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Jia Y, Zhong DR, Cui QC. Intraspinal clear cell meningioma: a case report. Chin Med J (Engl) 2005; 118:348-9. [PMID: 15740678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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81
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Bozkurt G, Ziyal IM, Akbay A, Dal D, Can B, Ozcan OE. Cauda-filar paraganglioma with 'silk cocoon' appearance on spinal angiography. Acta Neurochir (Wien) 2005; 147:99-100; discussion 100. [PMID: 15338341 DOI: 10.1007/s00701-004-0372-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 07/14/2004] [Indexed: 10/26/2022]
Abstract
'Silk cocoon' appearance on spinal angiography is pathognomonic to differentiate paragangliomas from several vascular tumors and malformations of cauda-filar region.
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82
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83
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84
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Dorta-Contreras AJ, Reiber H. [Molecular diffusion/cerebrospinal fluid flow theory]. Rev Neurol 2004; 39:564-9. [PMID: 15467996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM To review the fundamental aspects of the theory of the molecular flow/ cerebrospinal flux described recently and it can explained a group of events in the physiology of the cerebrospinal fluid and the physiopathology of neurological diseases. DEVELOPMENT This theory was based on the postulate that a decrease of the flux rate of the cerebrospinal fluid was accompanied by an increment of the protein concentration in it and in the nervous system tissue. The increment of the protein transport from the blood to the cerebrospinal fluid not require structural changes or an increase of permeability. The reibergram or Reiber's quotient diagram, with the discriminatory hyperbolic function with its theoretical basis and its clinical relevance confirm the acceptance of the present theory. This theory was based on the first and second Fick's diffusion laws The increment of the molecular diffusion is the cause of the non-linear decrease of the cerebrospinal flux rate because of the blood-cerebrospinal fluid barrier dysfunction. CONCLUSIONS This theory explain that an increase of the albumin quotient does not means a morphologic change on the barrier structures. The change in the cerebrospinal flux rate it has been considered the principal modulator of the protein concentration in cerebrospinal fluid in pathological conditions characterized by a blood-cerebrospinal fluid barrier dysfunction.
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85
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Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther 2004; 27:197-210. [PMID: 15129202 DOI: 10.1016/j.jmpt.2003.12.023] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide a qualitative systematic review of the risk of spinal manipulation in the treatment of lumbar disk herniations (LDH) and to estimate the risk of spinal manipulation causing a severe adverse reaction in a patient presenting with LDH. DATA SOURCES Relevant case reports, review articles, surveys, and investigations regarding treatment of lumbar disk herniations with spinal manipulation and adverse effects and associated risks were found with a search of the literature. DATA SYNTHESIS Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated. From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated. This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH. RESULTS An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million. CONCLUSION The apparent safety of spinal manipulation, especially when compared with other "medically accepted" treatments for LDH, should stimulate its use in the conservative treatment plan of LDH.
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86
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Sanz-Trelles A, Arranz-Salas IM, Valenzuela-Serrano MI. Melanoma arising in and limited to a spinal nerve root of the cauda equina. Histopathology 2004; 43:603-4. [PMID: 14636261 DOI: 10.1111/j.1365-2559.2003.01679.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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87
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Falavigna A, Righesso Neto O, dos Santos JAN, Ferraz FAP. Cavernous angioma of the cauda equina: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:531-4. [PMID: 15273858 DOI: 10.1590/s0004-282x2004000300029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present a rare case of cavernous angioma of the cauda equina and review the eleven cases available in the literature. A 44-year-old woman presented with low back pain and sciatica associated with bowel and bladder dysfunction and motor weakness of the lower extremity. The MRI revealed an enhancing, heterogeneous and hyperintense intradural lesion compressing the cauda equina roots at the L4 level. Laminectomy at L3-L4 and total removal of the tumor were performed without additional neurological deficit. Pathology revealed a cavernous angioma. The literature, clinical presentation, technical examinations, and treatment are reviewed.
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88
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Drozdowski W, Pogorzelski R. [Features of intracranial hypertension as a manifestation of cauda equina tumor]. Neurol Neurochir Pol 2004; 38:227-30. [PMID: 15354237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
A 61-year-old man was admitted to the Department of Neurology, Medical University of Białystok with signs of intracranial hypertension associated with headaches and papilledema, with no other signs of the nervous system dysfunction. CT and MRI brain scans were normal, cerebrospinal fluid contained 1620 mg/dl of proteins. One month later epileptic seizures with a loss of consciousness occurred. Brain CT and MRI scans showed no focal pathology and failed to disclose any intracranial tumor. The acute pain in the lumbar spine region made us perform an MRI scan of the lower spinal cord, which disclosed cauda equina tumor. The tumor was surgically removed and it was histopathologically concluded to be ependymoma. After the operation there were neither headaches nor seizures and we noticed an improvement in his vision acuity. In the postoperative course the patient suffered from urinary and bowel dysfunction. In this article we discuss a pathogenesis of intracranial hypertension occurring in spinal cord tumors and stress the need for a diagnosis of spinal cord lesions in patients with the elevated intracranial pressure.
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89
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KAPLAN A, UMANSKY AL. Myelographic defects of herniated intervertebral discs simulating cauda equina neoplasms. Am J Surg 2004; 81:262-78. [PMID: 14819468 DOI: 10.1016/0002-9610(51)90226-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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90
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WOLTMAN HW, KERNOHAN JW, ADSON AW, CRAIG WM. Intramedullary tumors of spinal cord and gliomas of intradural portion of filum terminale; fate of patients who have these tumors. ACTA ACUST UNITED AC 2004; 65:378-95. [PMID: 14810287 DOI: 10.1001/archneurpsyc.1951.02320030115010] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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91
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Pérez-López C, Sarmiento MA, Alvarez-Ruíz F, Gutiérrez M, Fernández-Prieto A, García-Raya P, Gómez-Sierra A, Isla A. Paragangliomas de la cauda equina: a propósito de dos casos. Neurocirugia (Astur) 2004; 15:565-70. [PMID: 15632992 DOI: 10.1016/s1130-1473(04)70445-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Extraadrenal paragangliomas involving the spinal cord are not common and usually take the compression of the cauda equine. Two cases of paraganglioma of the cauda equina with a different presentation are reported, and the clinical and histopathology findings of this tumor, as well as diagnosis, treatment and prognosis are review. We stress the importance of the high tumor vascularization form of intradural that can make impossible achieve a complete resection. Laminotomy and intraoperatory echography are very useful in the approach to intradural tumors, such as paraganglioma.
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92
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Despeyroux-Ewers M, Catalaâ I, Collin L, Cognard C, Loubes-Lacroix F, Manelfe C. Inflammatory myofibroblastic tumour of the spinal cord: case report and review of the literature. Neuroradiology 2003; 45:812-7. [PMID: 14517703 DOI: 10.1007/s00234-003-1069-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2002] [Accepted: 05/21/2003] [Indexed: 12/22/2022]
Abstract
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.
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93
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Prelog K, Blome S, Dennis C. Neurosarcoidosis of the conus medullaris and cauda equina. AUSTRALASIAN RADIOLOGY 2003; 47:295-7. [PMID: 12890252 DOI: 10.1046/j.1440-1673.2003.01180.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An uncommon case of neurosarcoidosis of the conus medullaris and cauda equina is described in a 24-year-old man with a 4-year history of urological symptoms and rash. Chest X-ray and biopsy confirmed sarcoidosis and MRI diagnosed conus medullaris involvement.
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94
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Bøge-Rasmussen T, Dons K, Gjerris F, Hauerberg J, Jubler M, Kosteljanetz M, Møller CM, Nielsen LB, Osgaard O, Poulsgaard L, Westergaard L. ["Lumbar examination" and cauda equina syndrome]. Ugeskr Laeger 2003; 165:3249; author reply 3249-50. [PMID: 12970998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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95
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Olsan AD, Milburn JM, Baumgarten KL, Durham HL. Leptomeningeal enhancement in a patient with proven West Nile virus infection. AJR Am J Roentgenol 2003; 181:591-2. [PMID: 12876053 DOI: 10.2214/ajr.181.2.1810591] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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96
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Ampil FL, Martinez RL, Jawahar A, Willis BK, Nanda A. Management of epidural cauda equina disease of prostate cancer by radiotherapy. RADIATION MEDICINE 2003; 21:145-9. [PMID: 14514119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE Secondary prostate cancer affection of the cauda equina (SPCCE) can be an ultimate cause of morbidity and mortality. Since the results of management of this particular disease condition remain largely unknown, a retrospective case review was undertaken to determine the effects of treatment by radiation in SPCCE patients. METHODS The records of 12 patients with SPCCE treated at the Division of Therapeutic Radiology during the period 1984 to 1998 were reviewed. The administered total radiation dosage ranged from 6 Gy to 32 Gy (average, 26.6 +/- 2.0 Gy). Two individuals underwent decompressive laminectomy and bilateral orchiectomy at the time of SPCCE and prostate cancer diagnoses. Ten patients had prior hormonal manipulative treatment (orchiectomy, estrogen, or Flutamide therapy). RESULTS Pain was relieved in three of four symptomatic patients (75%). Five of nine patients unable to walk before therapy could walk after treatment. One of two individuals with anal or bladder sphincter dysfunction improved following irradiation. The overall mean duration of survival was five months. With treatment, survival was approximately three times as long for ambulatory versus non-ambulatory patients. CONCLUSION We conclude that radiation treatment is efficacious in promoting palliation of SPCCE, although it may not prolong life.
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97
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Kurtkaya-Yapicier O, Scheithauer BW, Woodruff JM, Wenger DD, Cooley AM, Dominique D. Schwannoma with rhabdomyoblastic differentiation: a unique variant of malignant triton tumor. Am J Surg Pathol 2003; 27:848-53. [PMID: 12766593 DOI: 10.1097/00000478-200306000-00020] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 54-year-old woman presented with intractable perianal, bilateral buttock, and radiating thigh/calf pain. An MRI scan showed an intradural, contrast-enhancing, ovoid mass in the cauda equina region at L1-L2. At laminectomy, the ovoid mass arose from a nerve root and, intact, was gross totally resected. Histologically, the dominant pattern was that of schwannoma. One year thereafter, the symptoms recurred. An MRI scan demonstrated an irregular, heterogeneously enhancing tumor recurrence. A repeat laminectomy disclosed a large fleshy tumor involving multiple nerve roots. The lesion was subtotally resected and showed pluridirectional differentiation toward embryonal rhabdomyosarcoma, primitive neuroectodermal tumor, and rare malignant epithelial cells. Review of the original tumor disclosed only foci of embryonal rhabdomyosarcoma and primitive neuroectodermal tumor. Based upon available data regarding divergent differentiation in peripheral nerve sheath tumors, this is a unique, previously undescribed tumor demonstrating rhabdomyosarcomatous, primitive neuroectodermal tumor and scant epithelial differentiation in a schwannoma. In essence, it is a variant of malignant Triton tumor because of its origin in a tumor consisting of well-differentiated Schwann cells. It supports the contention that the Schwann cell is the source of a variety of heterologous elements in nerve sheath tumors.
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98
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da Costa LB, de Andrade A, Braga BP, Ribeiro CA. Cauda equina hemangioblastoma: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2003; 61:456-8. [PMID: 12894284 DOI: 10.1590/s0004-282x2003000300024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hemangioblastomas of the spinal cord are rare lesions, and those located at the cauda equina are even rarer. Most commonly these tumors are present in patients with von Hippel-Lindau (VHL) syndrome. We describe here the case of a 48 years old woman with a pure radicular hemangioblastoma, not associated with VHL, presenting with radicular pain, diagnosed with magnetic ressonance imaging (MRI) and submitted to total resection with a very good outcome. To our knownledge, this is the second report to describe the MRI aspect of histologically proved hemangioblastoma of the cauda equina in a patient without clinical criteria for VHL.
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99
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Macías Pingarrón JP, Torrado Criado MD, Alfonso Sanz F, Robles Barragán J, Gallego Córdoba JM. [Epidural hematoma after combined regional anesthesia in a patient without coagulation disorders]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2003; 50:209-10. [PMID: 12825310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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100
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Wessels PH, de Jong M. [Diagnostic image (125). A man with Bechterew's disease and dysfunctional defecation, micturition and erection. Cauda equina syndrome]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2003; 147:248. [PMID: 12621980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A 62-year-old man suffering from long-standing ankylosing spondylitis had a 5-year history of progressive difficulty of defecation, micturition and erection, due to complication by a cauda equina syndrome.
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