Clinics in diagnostic imaging (68). Intradural extramedullary spinal paraganglioma

Paragangliomas rarely present as spine tumours. The correct diagnosis is generally not suspected pre-operatively and initial imaging is often non-specific. A 36-year-old man with low back pain, and progressive leg numbness and weakness, was found to have an expansile intradural extramedullary spinal tumour on radiographs and magnetic resonance imaging. Surgery revealed a paraganglioma. The features of spinal paraganglioma and differential diagnosis of intradural extramedullary tumours are discussed.

An unusual presentation of solitary fibrous tumor

STUDY DESIGN

Case report of a lumbar extradural solitary fibrous tumor.

OBJECTIVE

To describe the clinical manifestations and successful treatment of a patient with solitary fibrous tumor of the lumbar spine.

SUMMARY OF BACKGROUND DATA

Solitary fibrous tumor usually occurs on the pleura but has been described in a growing number of sites. Although this is the first case in a lumbar extradural location, clinicians should be aware of the many guises in which this entity appears. Most cases are benign and cure is effected by surgical extirpation.

METHODS

The diagnosis, treatment, and outcome of a patient with a lumbar extradural solitary fibrous tumor are reviewed.

RESULTS

A patient showing signs of myeloradiculopathy was found, by means of magnetic resonance imaging, to have an intensely enhancing extradural lesion in the region of L1. Excision biopsy revealed features of a solitary fibrous tumor. The patient made a rapid, complete recovery.

CONCLUSIONS

Solitary fibrous tumor has protean clinical manifestations and should be be considered in the differential diagnosis of intraspinal enhancing lesions on either side of the dura.

The effect of changes in barometric pressure on the risk of rupture of intracranial aneurysms

Several meteorological variables have been linked with an altered incidence of cerebrovascular disease. In particular, we had noticed that, following abrupt changes in weather, patients with aneurysmal subarachnoid haemorrhage (SAH) often presented in groups. This study was undertaken to determine whether changes in barometric pressure would be an important factor. A retrospective analysis of a two year period was carried out. Daily mean, peak and trough atmospheric pressures had been recorded independently by a weather bureau. Of the 157 patients with SAH due to a berry aneurysm, confirmed by CT and angiography, 60 were entered into the study. Patients residing outside the weather bureau region (n = 86), or where there was uncertainty of their day of ictus (n = 11), were excluded. Daily peak to trough pressure changes and mean monthly pressure fluctuations showed no association with an increased risk of SAH. However, a significant relationship between the incidence of onset of symptoms indicative of a rupture of the aneurysm and a change in barometric mean pressure (BMP) of > 10 hectapascals from the previous day was found (p = 0.0247). The calculated odds ratio of sustaining a SAH with this associated BMP change was therefore 2.7 times with a risk of 1-13 times at a 95% confidence level (p = 0.035).