Spinal Epidural Inflammatory Pseudotumor: A Case Report and Review of Literature

Bhujabal, Siba Narayan; Nath, Pratap Chandra; Behera, Ranjit; Swarnakar, Pankaj Kumar; Dhir, Manmath Kumar; Mishra, Subhankar

doi:10.1016/j.wneu.2018.06.079

Cited by 9 publications

(5 citation statements)

References 16 publications

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“…IgG4-RD predominantly manifests in the pituitary gland, brain parenchyma, meninges, and peripheral nerves and rarely in the epidural tissue of the central nervous system ( 3 ). Spinal IPT in an extrapulmonary location is very rare, with it being most common in the cervical spine and occurring less frequently in the thoracic or thoracolumbar spine region ( 4 ). At the same time, they are predominantly located intradural extramedullary and rarely extradural or intramedullary.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) of the spine showed a subdural heterogeneous signal in the spinal canal at the level of the thoracic (3,4) vertebrae, while slight hyperintensity on T2WI and multiple nodular cystic signals were also shown. An enhanced scan showed obvious heterogeneous enhancement, and no obvious enhancement of the cystic area was observed in the lesion.…”

Section: Case Presentation Medical Historymentioning

confidence: 99%

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Immunoglobulin G4-Related Spinal Intramedullary Inflammatory Pseudotumor: A Case Report and Literature Review

Zhou

Liu

et al. 2022

Front. Neurol.

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Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disease that affects several organs. An inflammatory pseudotumor is a histologically proven benign tumor-like lesion that most commonly involves the lung and orbit. It is rare in the central nervous system, but rarest in the spinal canal. In this report, we present a case of IgG4-related intramedullary spinal inflammatory pseudotumor, along with a literature review. A 29-year-old male was transferred to the Department of Neurosurgery of Lanzhou University Second Hospital with progressive quadriparesis after numbness and weakness in both lower limbs for 50 days. Enhanced magnetic resonance imaging (MRI) of the spine revealed an isointense signal on T1-weighted images and a hyperintense signal on T2-weighted images from an enhanced mass located at the thoracic vertebrae region, for which a schwannoma was highly suspected. Then, a posterior median approach was adopted. The lesion was resected. The patient received further glucocorticoid after the diagnosis of an IgG4-related inflammatory pseudotumor was established, and the patient's symptoms improved, such as quadriparesis and lower limb weakness. This case highlights the importance of considering IgG4-related inflammatory pseudotumor as a differential diagnosis in patients with lesions involving the spinal intramedullary compartment and lower limb weakness when other more threatening causes have been excluded. IgG4-related inflammatory pseudotumor is etiologically unclear and prognostically unpredictable, and imaging may not help establish the diagnosis of IgG4-related inflammatory pseudotumor due to its resemblance to malignant tumors, and total resection might not be warranted. Glucocorticoid and surgery are usually the first-line treatments used.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentation Medical Historymentioning

confidence: 99%

Immunoglobulin G4-Related Spinal Intramedullary Inflammatory Pseudotumor: A Case Report and Literature Review

Zhou

Liu

et al. 2022

Front. Neurol.

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“…Commonly reported etiologies for epidural granulomas include postcatheter placement, inflammatory pseudotumor, sarcoidosis, and infectious etiology (16)(17)(18)(19)(20). Iatrogenic epidural hematomas are potential complications following epidural injections, and while the calcifications of hematomas can occur, this phenomena remains a rare entity (21).…”

Section: Discussionmentioning

confidence: 99%

A Rare Calcified Complication of Epidural Injections for Lumbar Spinal Stenosis: A Case Presentation and Literature Review

Majdalani¹,

Mares²,

Shédid³

et al. 2022

PMCR

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BACKGROUND: Neurogenic claudication secondary to degenerative lumbar stenosis is typically managed with nonsurgical options, such as epidural corticosteroid injections. As a standard and effective treatment for lumbar stenosis, clinicians must be aware of the corticosteroids choice when injecting in the epidural space. CASE REPORT: A 62-year-old man presenting with sciatic pain is treated with multiple neuroforaminal, facet, and caudal corticoid injections over the course of several months without any symptomatic resolution. A magnetic resonance imaging of his lumbar spine revealed focal bilateral central stenosis at the L4-L5 level. A computed tomography revealed hyperdense lesions at that level. The patient was referred for a surgical option. He underwent complete minimally invasive resection of the bilateral lesion with instrumented and interbody fusion. The final pathology report identified the mass as a calcified granuloma. CONCLUSIONS: Following repetitive methylprednisolone acetate injections, one must be aware of all the potential complications arising from particulate corticosteroids. KEY WORDS: Spinal stenosis, epidural injections, granulomas, corticosteroids

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“…13,14 Incluso se han reportado casos con localización espinal epidural. 13,15 La localización en la base del cráneo suele estar asociada con un comportamiento agresivo, mostrando erosión ósea, altas tasas de recidivas, respuesta pobre al manejo farmacológico y la radioterapia. 4 El PI intracraneal con compromiso del seno cavernoso, asociado con oftalmoplejía dolorosa, fue descripto por Tolosa y Hunt et al (Sindorme de Tolosa-Hunt) 16,17 , caracterizado por un proceso inflamatorio no específico que implicaba el seno cavernoso con infiltración de adventicia de la carótida.…”

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Villaescusa,

Guerra,

Plou

et al. 2022

Rev. Argent. Neuroc.

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Spinal Epidural Inflammatory Pseudotumor: A Case Report and Review of Literature

Cited by 9 publications

References 16 publications

Immunoglobulin G4-Related Spinal Intramedullary Inflammatory Pseudotumor: A Case Report and Literature Review

Immunoglobulin G4-Related Spinal Intramedullary Inflammatory Pseudotumor: A Case Report and Literature Review

A Rare Calcified Complication of Epidural Injections for Lumbar Spinal Stenosis: A Case Presentation and Literature Review

Este caso me desorientó

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