1
|
Zhang D, Fan T, Fan W, Wang Y. Spinal intradural schwannoma presenting with acute subarachnoid hemorrhage: a case report and review of published reports. J Int Med Res 2022; 50:3000605221075814. [PMID: 35099308 PMCID: PMC8811432 DOI: 10.1177/03000605221075814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Acute subarachnoid hemorrhage (SAH) presentation is a very rare occurrence in spinal schwannomas. We report a case of lumbar schwannoma in a patient presenting first with acute SAH. A 40-year-old man was referred to our department 7 days after the sudden onset of headache, neck pain, and fever. SAH was suspected; however, head computed tomography (CT) findings were normal. A lumbar puncture indicated blood-stained cerebrospinal fluid (CSF). Moreover, the CSF pressure changed from 200 mmH2O to 90 mmH2O after drainage of 10 mL of CSF indicating a blockage of CSF. Subsequent magnetic resonance imaging (MRI) confirmed an intradural tumor with SAH, which also caused blockage of the CSF circulation. The patient underwent immediate surgery and fully recovered. In conclusion, the early diagnosis and total removal of the tumor and blood clot significantly improved the patient’s outcome. There is a high index of suspicion for spinal tumors resulting in SAH when there is a CSF pressure change after lumbar puncture in an SAH patient.
Collapse
Affiliation(s)
- Dongao Zhang
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tao Fan
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wayne Fan
- Faculty of Science, University of British Columbia, Vancouver, Canada
| | - Yinqian Wang
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
2
|
Fabbri VP, Friso F, Chiarucci F, Gramegna LL, Toni F, Foschini MP, Asioli S, Cremonini A, Acciarri N. Hemorrhagic Schwannoma of the Cauda Equina: Case Report and Review of the Literature. NMC Case Rep J 2022; 8:377-385. [PMID: 35079492 PMCID: PMC8769457 DOI: 10.2176/nmccrj.cr.2020-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022] Open
Abstract
Spinal intradural hemorrhage is a rare event; the most common causes of spinal bleeding are traumas, medical therapy with anticoagulants and thrombolytics, vascular malformations, and congenital defects of coagulation. Rarely, spinal cord tumors may cause hemorrhage. Herein, we report the case of a patient with acute and quickly worsening lumbar pain: the neurological examination revealed a flaccid paraplegia caused by an intradural lesion extending on the right side of the spinal cord from T1 to L2 vertebral level. Pathological examination revealed an hemorrhagic schwannoma. Acute spinal subdural hemorrhage caused by spinal schwannomas is a very rare occurrence (29 cases only have been previously reported). Review of the literature with clinico-diagnostic features is presented, surgical treatment is explained, and pathological findings with possible etiopathogenesis of hemorrhage are described.
Collapse
Affiliation(s)
- Viscardo P Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Filippo Friso
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS/Institute of Neurological Science of Bologna, Department of Neurologic Surgery, Bellaria Hospital, Bologna, Italy
| | - Federico Chiarucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Laura Ludovica Gramegna
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS/Institute of Neurological Science of Bologna, Unit of Functional and Molecular Neuroimaging, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- IRCCS/Institute of Neurological Science of Bologna, Unit of Neuradiology, Bellaria Hospital, Bologna, Italy
| | - Maria P Foschini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Anna Cremonini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Nicola Acciarri
- IRCCS/Institute of Neurological Science of Bologna, Department of Neurologic Surgery, Bellaria Hospital, Bologna, Italy
| |
Collapse
|
3
|
Chen P, Guo Y, Huang R, Xiao J, Cheng Z. Spinal schwannoma causes acute subarachnoid haemorrhage: A case report and literature review. Neurochirurgie 2021; 67:495-499. [PMID: 33450272 DOI: 10.1016/j.neuchi.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/23/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spinal schwannomas that arise from spinal nerve root sheaths are the most common intradural extramedullary spinal tumours and are often accompanied by nerve roots or spinal cord irritation symptoms. The phenomenon of spinal schwannoma causing subarachnoid haemorrhage (SAH) is rare, with ependymoma of the conus medullaris accounting for most cases. CASE REPORT A 45-year-old man was admitted to our hospital due to progressive lower limb weakness and sudden back pain after hard physical work. The patient had not been able to walk for 2hours upon admission. An emergency magnetic resonance imaging (MRI) scan showed that the spinal cord at the C6-T4 level was severely compressed by a subdural mass. During the emergency operation, exploration of the dura and arachnoid mater revealed a fresh blood clot covering a tumour located on the ventral side of the spinal cord. The size of the tumour was approximately 3×2×1cm without adhesion to the surrounding tissue, but the drainage vein was ruptured. Postoperative pathology showed that the tumour was a schwannoma with areas of fresh haemorrhage and focal necrosis. CONCLUSIONS Spinal schwannomas presenting with SAH are rare events. In our opinion, spinal pathology with rapid progression of neurological symptoms requires early diagnosis and emergency management. Complete excision of haemorrhagic tumours is the goal of treatment to prevent recurrence, which can effectively avoid irreversible damage to the spinal cord resulting from spinal cord compression.
Collapse
Affiliation(s)
- P Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde road, 330006 Nanchang, Jiangxi, China.
| | - Y Guo
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde road, 330006 Nanchang, Jiangxi, China.
| | - R Huang
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde road, 330006 Nanchang, Jiangxi, China.
| | - J Xiao
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde road, 330006 Nanchang, Jiangxi, China.
| | - Z Cheng
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde road, 330006 Nanchang, Jiangxi, China.
| |
Collapse
|
4
|
Dobran M, Nasi D, Della Costanza M, Formica F. Intralesional and subarachnoid bleeding of a spinal schwannoma presenting with acute cauda equina syndrome. BMJ Case Rep 2019; 12:12/7/e229251. [PMID: 31302617 DOI: 10.1136/bcr-2019-229251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present an unusual case of spinal neurinoma with intralesional and subarachnoid bleeding with acute cauda equina syndrome. A 38-year-old man was admitted to our department after a minor thoracic spinal trauma with right lower limb plegia and urinary retention. MRI showed a T11 intradural tumour with intralesional and subarachnoid haemorrhage. The patient was operated of spinal cord decompression and complete tumour resection. The histological examination documented a schwannoma with large haemorrhagic intratumoural areas. A full neurological recovery was documented at 6-month follow-up.
Collapse
Affiliation(s)
- Mauro Dobran
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Davide Nasi
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | | | - Francesco Formica
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|