Intradural Extramedullary Hemangioblastoma Differentiated by MR Images in the Cervical Spine

Toyoda, Hiromitsu; Seki, Mitsunori; Nakamura, Hiroaki; Inoue, Yuichi; Yamano, Yoshiki; Takaoka, Kunio

doi:10.1097/01.bsd.0000083630.91606.af

Cited by 20 publications

(15 citation statements)

References 12 publications

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“…The presence of small hypointense, round, well‐defined areas, mainly at the dorsomedial margin of the tumour, suggest prominent vessels located directly adjacent to the tumour. These findings indicate draining vessels and are often observed in a haemangioblastoma …”

Section: Discussionmentioning

confidence: 65%

“…In veterinary medicine, where high‐field MRI systems are not widely used, identifying the exact location of a spinal tumour can be extremely difficult, especially to discern between intramedullary–extramedullary and intradural–extramedullary tumours . The most important features detected on MRI that can be used to differentiate an intramedullary–extramedullary tumour from an intradural–extramedullary tumour are the presence of a syrinx or oedema that has spread lengthwise along the craniocaudal sides of the tumour and the presence of the ‘snowman sign’ on transverse images.…”

Section: Discussionmentioning

confidence: 99%

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Intradural–extramedullary haemangioblastoma with paraspinal extension in a dog

et al. 2015

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Haemangioblastoma is an extremely rare neoplasm in animals and only two cases of this tumour have been reported, but in other anatomical locations. Haemangioblastomas in human patients are more commonly located in the cerebellum and intradural-extramedullary growth is extremely rare. The dog in this study responded favourably to combined surgery and metronomic chemotherapy and was clinically normal 1 year after surgery.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Intradural–extramedullary haemangioblastoma with paraspinal extension in a dog

et al. 2015

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“…Vascular lesion of left side, either cerebral or brainstem lesion, is naturally considered to be the first item on the differential diagnosis list. 9,10 Unfortunately brain imaging studies proved otherwise. Detailed history is of upmost importance in terms of neurologic localization since symptoms such as neck pain/ sore, unexplained constant head and shoulder sprain, and habitual neck manipulation could be so vague that even first line physician easily overlooked.…”

Section: Discussionmentioning

confidence: 99%

“…A lesion that influence right cortico-spinal tract could be responsible right side hemiparesis as shown in our patient. 4,9,10 Hence cervical spine lesion should be kept in mind when encountered with patients afflicted with hemiparesis despite its rarity. 10,11 One unique and unusual presentation in our patient is the sole motor symptom manifestation with sparing of subjective sensory complaint and objective neurological findings.…”

Section: Discussionmentioning

confidence: 99%

Cervical spine intradural-extramedullary hematoma presenting as ipsilateral hemiparesis

Lin

2011

Neurol Int

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A 75-year-old Taiwanese man suffered from acute onset of right-sided extremity weakness while talking to his neighbors. He was transferred to the hospital within three-hour time after symptom onset. Initial acute ischemic cerebral infarct was diagnosed based on his symptom and cerebral computed tomography. Thrombolytic therapy was held after his symptom improved promptly and could not excluded other etiology. Thorough history taking unraveled previous Chinese medicine clinic visit because of neck sore. However, he received limited improvement after several times of massage treatment. Magnetic resnance imaging (MRI) of the cervical spine demonstrated hematoma compressing right side intradural-extramedullary space at the C2/C3 level. Through his clinical course, muscle weakness was the sole neurological finding with sparing of sensory defects. Given the close anatomy relationship between sensory and motor lamina distribution in the cervical spinal cord, our patient presented a rare manifestation. Cases of cervical spine intradural-extramedullary hematoma are not often seen and only sporadic in the documented literature. We wish, through the report of this article, to inform the first- line physicians with the following information. Among the elderly, neck sore is a common symptom. Over- stretching or overt local massage is not suggested due to relatively fragile musculature. In the clinical diagnosis and localization of lesion, cerebral or cervical spine lesion could mimic with each other and manifest hemiparesis as their first symptom. Meticulous history taking, neurological/ physical examination and pertinent laboratory work-up should be done before initiation of intravenous thrombolytic therapy as it could cause catastrophic consequences if not used properly.

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“…Hemangioblastomas and cavernous malformations account for ~5% of intramedullary lesions and infrequently can be found extramedullary in association with nerve roots. 5,[19][20][21][22] Metastatic lesions, germinomas, and lymphomas can also present as intradural mass lesions. 5 Spinal cord arteriovenous malformations (AVMs) and fistulas as well as vascular aneurysms may occur.…”

Section: Casementioning

confidence: 99%

11 Intramedullary and Extramedullary Spinal Cord Tumors

Albert¹,

Lee²,

Lim³

2008

Cervical Spine Surgery Challenges

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A 34-year-old male experienced episodes of stumbling and falling 2 months prior to presentation. The patient first developed left leg numbness and weakness that progressed to his right leg. The sensory disturbance and weakness manifested as gait difficulties. He denied bowel, bladder, or sexual dysfunction. The patient's past medical history and family history were noncontributory.On physical examination, the patient had normal upper extremity strength and reflexes. He had normal pinprick and joint position sense bilaterally in his upper extremities. His right lower extremity exhibited 5/5 strength during hip flexion, 4/5 strength during knee extension, and 2/5 strength when dorsiflexing and plantar flexing the ankle. His left lower extremity revealed 4/5 strength during dorsiflexion and plantar flexing the ankle and normal strength proximally. Sensory loss to pinprick and temperature was observed bilaterally below the chest but joint position sense was intact. His lower extremity reflexes were normal and his toes were downgoing after Babinski reflex testing. He had normal cutaneous perianal sensation and rectal tone.During his evaluation the patient had a brain, as well as cervical, thoracic, and lumbar spine magnetic resonance imaging (MRI) with and without gadolinium. The scan demonstrated an intradural-extramedullary mass with significant cord compression at the cervical-thoracic junction ( Fig. 11-1). The mass enhanced homogeneously and originated dorsal to the spinal cord. A small enhancing dural tail was appreciated.The patient was taken to the operating room and underwent an osteoplastic laminectomy and resection of the lesion. Pathology demonstrated that the lesion was consistent with a meningioma. Gross total resection was achieved. The dural base of the tumor was excised. Duraplasty was performed with dural substitute. Throughout surgery, all epidural and muscle motor evoked potentials were stable. Postoperatively the patient's strength was at his preoperative baseline and has since begun to improve. Case 2A 24-year-old female first complained of intermittent cervical pain 12 months prior to presentation. Originally, the pain was not severe and it did not recur frequently. Over the ensuing 12 months, however, the cervical pain worsened and became more frequent. Eventually the pain intensified and she had difficulty getting out of bed. The patient did not experience any other sensory abnormality. The patient did not complain of weakness or bowel or bladder dysfunction. Secondary to the increasing pain, the patient went to her physician who performed a detailed physical examination and ordered radiological examinations.On examination the patient exhibited full, symmetric strength in her upper and lower extremities. Pinprick sensation and joint position sense were bilaterally intact in her upper and lower extremities. Her reflexes were normal and her toes were downgoing when the Babinski reflex was elicited. She had normal cutaneous perianal sensation and rectal tone.Plain films revealed mild scoliosis. A...

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Intradural Extramedullary Hemangioblastoma Differentiated by MR Images in the Cervical Spine

Cited by 20 publications

References 12 publications

Intradural–extramedullary haemangioblastoma with paraspinal extension in a dog

Intradural–extramedullary haemangioblastoma with paraspinal extension in a dog

Cervical spine intradural-extramedullary hematoma presenting as ipsilateral hemiparesis

11 Intramedullary and Extramedullary Spinal Cord Tumors

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