Cases reported "Spinal Cord Neoplasms"

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1/16. adult T-cell lymphoma involving the leptomeninges associated with a spinal cord schwannoma.

    adult T-cell lymphoma (ATL-L) developing initially in the meninges is rare. An autopsy case of ATL-L with an acute onset of meningitis and generalized lymphadenopathy in association with a cervical cord schwannoma is reported here. A 78-year-old woman with sensori-motor weakness of both arms over a 1-year period, developed febrile episodes and drowsiness with neck stiffness. Lumbar puncture revealed an increased protein content (161 mg/dL) and increased cell count (463/3) consisting of 99% of lymphocytes which contained atypical lymphocytes with multilobulated nuclei ('flower cells'), which are characteristic of ATL-L. Viral titers were positive only for htlv-i antibodies (serum X 640: CSF X 16). biopsy of an enlarged retroperitoneal lymph node revealed malignant lymphoma of the T-cell type. brain MRI was negative, whereas an intradural extramedullary mass was found at the C4 level. With a diagnosis of ATL-L stage IV, chemotherapy was commenced, which was effective in reducing the generalized lymphadenopathy as well as the cervical mass and restoring the CSF findings to normality. The cervical cord mass was verified to be a solitary schwannoma, and ATL-L involvement was found not only in the leptomeninges, but also within the cervical cord schwannoma.
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2/16. papilledema as the presenting manifestation of spinal schwannoma.

    A 63-year-old woman with headache, blurred vision, bilateral optic disc edema, and normal cranial magnetic resonance imaging scan underwent lumbar puncture that revealed an elevated opening pressure (290 mm water), a protein level of 114 mg/dl, and mild pleocytosis. Spinal magnetic resonance imaging later demonstrated a sacral tumor, which proved to be a schwannoma with sarcoid-like features. After surgical removal of the tumor, the patient's manifestations resolved. This case emphasizes that low spinal cord tumors can cause elevated intracranial pressure without causing markedly elevated cerebrospinal fluid protein or cells, or any myelopathic manifestations, perhaps by obstructing sacral cerebrospinal drainage. Comprehensive spine imaging should be a part of the evaluation of a patient with papilledema who has normal brain imaging but abnormal spinal fluid constituents.
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3/16. Intracranial subdural hematoma after resection of a thoracic spinal cord tumor.

    Intracranial subdural hematoma associated with intracranial hypotension is a rare complication of dural puncture and other procedures on the dura. This report describes the case of a 25-year-old man who developed intracranial subdural hematoma after resection of a thoracic spinal cord tumor. Intracranial subdural hematoma could result in severe and permanent neurologic deficit if it remains unrecognized. Severe and prolonged postdural puncture headache should be regarded as a warning sign of an intracranial subdural hematoma, and in those patients early investigation is recommended.
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4/16. Percutaneous spinal cord puncture and myelocystography. Its role in the diagnosis and treatment of intramedullary neoplasms.

    Three patients with cystic tumors of the cervical spinal cord were evaluated with percutaneous cord puncture and myelocystography. This procedure gives relief of symptoms and permits delineation of the extent and character of the cystic mass.
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5/16. Suboccipital lateral injection of intrathecal chemotherapy in a patient with mantle cell lymphoma.

    BACKGROUND: Even today patients who suffer from mantle cell lymphoma have a poor prognosis, especially when the CNS is involved. To confirm the diagnosis of meningeosis lymphomatosa, asservation of the liquor cerebrospinalis is necessary. During this procedure, intrathecal chemotherapy may be given if there is clinical evidence of meningeosis. If lumbar puncture cannot be performed, a lateral suboccipital puncture may be an alternative approach. patients AND methods: We report the case of a 65-year-old patient who suffered from mantle cell lymphoma stage IV. The patient presented with symptoms of progressive paraparesis of both legs and incontinence, with tumor mass intradural from the 12th thoracic vertebra to the level of S1. During irradiation, the patient developed symptoms of diffuse meningiosis lymphomatosa. The conventional lumbar puncture was impossible, because of tumor present in the thoracico-lumbar junction. RESULTS: A suboccipital puncture was performed for both collecting cerebrospinal fluid and application of chemotherapy (cytosine arabinoside/dexamethasone). This lead to remarkable improvement of the patient's clinical symptoms. CONCLUSIONS: The suboccipital cervical puncture was performed without complications. A variation of the intrathecal approach is described, which may serve as alternative when conventional lumbar puncture is not possible.
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6/16. hydrocephalus as the initial presentation of a spinal cord astrocytoma associated with leptomeningeal spread.

    A 3-year-old boy presented with headaches, vomiting, lethargy and papilledema. Communicating hydrocephalus along with transependymal fluid absorption and meningeal contrast enhancement was identified on CT. The enhancement was initially thought to be the result of a partially treated meningitis (child was previously on oral antibiotics for a presumed mycoplasma pneumonia). A right ventricular-peritoneal shunt was placed. CSF studies procured during the procedure were all normal. In contrast, CSF from a lumbar puncture contained a high protein, and cytology was highly suspicious for malignancy. spine MRI showed diffuse leptomeningeal enhancement and a 1.5-cm intramedullary lesion at T12-L1 associated with minimal edema. The lesion was subtotally resected (70%) and diagnosed as an astrocytoma (mostly Kernohan grade 2 but with areas of grade 3). Chemotherapy was administered and follow-up spine MRI at 2 months did not reveal any residual tumor, however, the leptomeningeal enhancement persisted. Sixteen months later, at the completion of the chemotherapy and radiation therapy, the spine MRI remained unchanged. Neurological examination has always been normal. This case illustrates how a spinal cord astrocytoma can metastasize via spinocranial dispersion and present early with hydrocephalus rather than myelopathy.
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7/16. Intramedullary spinal cord and leptomeningeal metastases in a patient with carcinoma of the uterine cervix.

    BACKGROUND.: Neoplastic meningitis in patients with carcinoma of the uterine cervix is unusual in the course of their diseases. Even more unusual are intramedullary spinal metastases. CASE: We report the case of a 64-year-old woman who presented with leptomeningeal and intramedullary spinal cord metastases from a grade 2 squamous cell cancer of the uterine cervix. This is just the second case of intramedullary metastases from cervical carcinoma. CONCLUSION: Neoplastic meningitis or intramedullary metastases are extremely rare in the course of uterine cervix carcinoma. Nevertheless, when indicated by symptoms, patients should undergo MRI of the brain and/or spine and have a lumbar puncture performed, for the diagnosis of this devastating complication. Treatment is mainly palliative but may offer symptom relief.
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8/16. Haemorrhagic necrosis of the grey matter of the spinal cord due to accidental injection of iopamidol in a patient with multiple neurofibromas; a clinico-pathological study.

    Cervical laminectomy was performed in a 34-year-old man with multiple spinal neurofibromas because of a slowly progressive medullary compression. Four weeks later a rapid deterioration necessitated iopamidol myelography by left lateral cervical puncture at C2 level. Despite the establishment of adequate spinal fluid contact, resulting in imaging of the subarachnoid space, part of the contrast medium entered the spinal cord, thus delineating a syrinx from the upper cervical extending to the upper thoracic level. After the puncture the patient developed triplegia, involving the left arm and both legs and a paresis of the right arm. He died from aspiration pneumonia. autopsy revealed haemorrhagic necrosis of the spinal grey matter. This adverse effect of myelography is argued to have been conditioned by the extreme immobility and displacement of the spinal cord due to the presence of multiple neurofibromas. The deterioration four weeks after the operation was probably caused by a further compression of the spinal cord.
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9/16. Combined CT metrizamide syringography and needle aspiration of cystic intramedullary spinal cord lesions.

    A modified spinal cord puncture technique that was combined with CT metrizamide syringography for the evaluation of potentially cystic spinal cord lesions has been used in 5 patients. This procedure proved to be safe and efficacious in the preoperative differentiation of cystic neoplasms from syringohydromyelia. It also aided in planning a surgical approach by revealing details of the tumor location and/or syrinx dynamics. spinal cord puncture associated with CT metrizamide syringography has a role in the diagnosis and therapy of patients with cystic spinal cord lesions.
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10/16. Intraspinal epidermoid tumors caused by lumbar puncture.

    It is well known that congenital intraspinal epidermoid tumors, while rare, do occur. That they may also be related to spinal puncture is less well understood. In the present article, four such cases are described, including one in which an earlier myelogram performed because of lumbar disk disease showed that no tumor was present prior to the spinal puncture. The pertinent literature is reviewed, and the probable mechanism of formation of such tumors and the means for avoiding it are discussed.
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