Title of the article: INTRAMEDULLARY THORACIC SPINAL CORD CAVERNOMAAbstract: Cavernomas of the spinal cord are rare vascular malformation. The true incidence of spinal cavernoma is unclear, but with a widespread use of magnetic resonance imaging, the number of cases is increasing. These account for 5% to 12 % spinal cord vascular malformations, with 3% reported being intradural and intramedullary in location.
Intramedullary cavernoma, though reported in the literature, are very rare. Because of rarity, we report a case of thoracic intramedullary spinal cavernoma that presented to our institute.Keyword: Spinal cavernoma, spinal cord, vascular malformationIntroduction:Spinal cavernomas are angiographically occult rare vascular malformations of the central nervous system. These account for 5% to 12 % spinal cord vascular malformations4 with 3% reported being intradural and intramedullary in location.
Subjects and Methods:Case report:A 26-year-old male presented with history in the right lower limb weakness since one and half years, slowly progressing over last 2 to 3 months.On examination: no evidence of cranial nerve palsy. Power: Bilateral upper limb: 5/5, Grip: 100%, Lower limb: right: 4/5, left: 5/5 Ankle clonus: positive, Right Knee and ankle jerk: Brisk, Plantar: extensor in the right lower limbImaging: A well defined multilobulated intramedullary lesion was seen in the upper thoracic cord (Figure 1).
The lesion appears T1 hyperintense Fgure 2andT2 heterointense with peripheral hypointense rimFigure 3 and hyperintense fociFigure 3 within the lesion at D1-D2 dorsal spine suggestive of cavernoma.Discussion:Background: Spinal cavernomas are angiographically occult rare vascular malformations of the central nervous system. These account for 5% to 12 % spinal cord vascular malformations 1, with 3% reported being intradural and intramedullary in location. Thoracic spinal cord most commonly affected followed by cervical cord 2. This can cause both acute and chronic compressive myelopathy 3 Clinical Presentation: Tend to become clinically apparent during the third and fourth decades of life and show slightly more female preponderance 2.These may be asymptomatic or may have a variable clinical presentation.
Most commonly progressive neurological deterioration or acute onset neurological deficits3. Latter due to hemorrhage.Diagnostic Features: Heterogeneously mixed signal intensity on T2WI with the peripheral hypointense rim of haemosiderin which show susceptibility blooming on gradient echo sequence with no contrast enhancement1,2.Differential Diagnosis:Spinal ependymomas: Presence of solid component with avid enhancement and associated perilesional edema.
May show scalloping of the posterior wall of the vertebral bodiesAstrocytomas: More common in children. Avid enhancement, perilesional edema. Haemorrhage is rare.Spinal arteriovenous malformation: Multiple flow voids, enlarged perimedullary-draining veins, may present with hematomyelia when ruptured. The absence of low-T2 capsule.
Treatment: Microsurgical resection if symptomatic. (4)