Recurrent lumbar ependymoma presenting as headache and communicating hydrocephalus

Two cases of normal pressure hydrocephalus caused by ependymoma of the cauda equina

Background:

Normal pressure hydrocephalus (NPH) associated with tumors of the cauda equina is rare. Here, we report two cases of NPH attributed to cauda equina ependymomas.

Case Description:

A 63-year-old male presented with progressive gait disturbance, dementia, and urinary incontinence. When the lumbar MR documented an intradural tumor involving the cauda equina at the L2-L3 level; the tumor was excised; pathologically, it proved to be a myxopapillary ependymoma. Postoperatively, however, the patient’s continued gait disturbance led to a brain CT that documented ventricular dilation consistent with NPH; following ventriculoperitoneal (VP) shunt placement his symptoms improved. A 65-year-old female also presented with gait disturbance, dementia, and urinary retention. Here, procedures were performed in reverse. When a brain CT showed hydrocephalus, a VP shunt was placed. When symptoms persisted, a lumbar MR demonstrated a T12-L2 intradural tumor; following a lumbar laminectomy for tumor excision, symptoms stabilized. The pathological diagnosis was also consistent with a conus/cauda equina ependymoma. Over the next 10 years, the patient had residual bladder dysfunction (e.g., requiring straight catheterization), but had no shunt dysfunction.

Conclusion:

We observed two cases of ependymomas of the cauda equina and brain CTs documenting NPH that was successfully surgically managed with stabilization of neurological deficit. In the first case, L2-L3 laminectomy for tumor removal was succeeded by shunting for NPH, while in the second case, initial VP shunting for NPH was followed by a T12-L2 laminectomy for tumor excision.

Spinal paraganglioma presenting as normal pressure hydrocephalus: a rare occurrence

Objective: We report a 63 years old female who presented with confusion, urinary retention and gait disturbances.Method: CT head shows communicating hydrocephalus. Spinal MRI demonstrated an L5- S1 intradural lesion.Result: Histopathology proved it to be paraganglioma. Postoperative CT head showed reduction in size of ventricles. Association between spinal tumors and hydrocephalus is known but occurs infrequently.Conclusion: The presence of an intraspinal tumor must be kept in mind as a possible cause of the hydrocephalus.

Intraspinal tumors accompanied by hydrocephalus: case report, systematic review, and discussion of treatment strategy

INTRODUCTION

Intraspinal tumor accompanied by hydrocephalus is an unusual but well-documented condition. Although many authors have proposed a variety of possible causes, the etiology is still unknown. Meanwhile, little has been discussed about the treatment strategy.

CASE REPORT

We report a case of intraspinal neurinoma accompanied by hydrocephalus. The patient presented with numbness and weakness of the legs, incontinence, and headache. Computed tomography scan demonstrated hydrocephalus and obvious peri-ventricular edema. She was given ventriculoperitoneal (V-P) shunt, but the shunt system had to be removed due to a postoperative intracranial hematoma. To our surprise, the hydrocephalus resolved after the tumor resection. We reviewed the literature and discussed a reasonable treatment strategy for this condition.

CONCLUSIONS

In patients presenting with hydrocephalus of unclear etiology, attention should be paid to possible spine pathology. If an intraspinal neurinoma is found, a V-P shunt is usually not necessary. A V-P shunt is only indicated when hydrocephalus does not improve after tumor resection.

Paraganglioma of the filum terminale presenting with normal pressure hydrocephalus

We describe a patient with an intraspinal paraganglioma who presented with normal pressure hydrocephalus. A 70-year-old man presented with a 6-month history of gait disturbance and cognitive dysfunction. Computed tomography of the brain and magnetic resonance imaging of the spine revealed communicating hydrocephalus and a spinal mass at the T12-L1 level which proved to be a paraganglioma of the filum terminale. Radioisotope cisternography revealed a severe delay in cerebrospinal fluid circulation. Symptoms related to communicating hydrocephalus resolved after tumor resection.

Ependymoma of the cauda equina starting with communicating hydrocephalus: a case report

The presence of concomitant hydrocephalus in cases with spinal cord tumors is relatively rare. Here, we describe a case of myxopapillary ependymoma of the cauda equina starting with communicating hydrocephalus in a 14-year-old boy. The patient presented to the clinic without underlying causes of hydrocephalus on the neuroimaging data. After ventriculoperitoneal shunt placement, despite the numerous malfunction incidents, the patient was doing well. Eight years later, he developed progressive weakness and coldness of the lower limbs. Multiple cystic lesions in the cervicothoracic area were found on magnetic resonance imaging. Decompressive hemilaminectomy of the cervicothoracic region was performed with temporary improvement of the patient's condition. Because of persisting complaints, the sacral area of the spine was also observed and neuroimaging data for a tumoral lesion in the cauda equina region were found. The lesion was surgically removed and the histological result was myxopapillary ependymoma. Therefore, cases presenting with internal hydrocephalus without clear-cut intracranial etiology should have detailed neuroimaging of the whole central nervous system.

Action at a distance: a lumbar spine tumor presenting as trigeminal neuralgia

Trigeminal neuralgia (TN) is often secondary to an underlying structural cause, frequently compression of the fifth nerve root by an ectatic artery. Here we describe a case of a 36-year-old woman with symptoms of TN who was found to have severe communicating hydrocephalus. Further investigation revealed a lumbar myxopapillary ependymoma, which in turn was responsible for the communicating hydrocephalus. An argument connecting these seemingly disparate findings is made. This unusual set of circumstances is an example of "action at a distance" in the nervous system, and reminds clinicians to think broadly about the various pathophysiologic mechanisms that can potentially underlie common disorders.