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Intramedullary cavernoma presenting with hematomyelia: report of two girls.

Cornips EM, Vinken PA, Ter Laak-Poort M, Beuls EA, Weber J, Vles JS - Childs Nerv Syst (2009)

Bottom Line: MR after 3.5 years shows minimal cord swelling no longer suggesting active residual cavernoma.However, subtotally resected lesions and/or syndromal cases may recur, requiring further treatment.Definitive answers await more cases with longer follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. e.cornips@mumc.nl

ABSTRACT

Introduction: Less than 20 children with intramedullary cavernoma (ImC) have been reported in the English literature; however, cases with an unfavorable outcome may be underreported. Whereas these are predominantly boys, we report two girls who presented with hematomyelia (one cervical, one thoracic) and an acute, severe neurological deficit.

Case material: A 10-year-old girl complaining about lower thoracic pain for several days suddenly developed lower body dysesthesias and paraparesis. Magnetic resonance (MR) demonstrated hematomyelia (T8-T11), intramedullary edema (T6-L1), and an ImC at T9-T10. Within an hour, she progressed to paraplegia and was therefore operated immediately. She slowly recovered regaining independent ambulation and continence. MR after 2 years shows no recurrence. A 7-year-old girl suddenly developed cervicalgia and paresis of her left arm and leg. MR demonstrated hematomyelia and an ImC at C4-C6. She gradually recovered with minimal residual deficit at 3 months and was subsequently operated uneventfully. Multiple cerebral cavernomas and a familial autosomal cavernous malformation syndrome were diagnosed. The following 1.5 years, she complained of intermittent cervicalgia and left brachial dysesthesias, with MR suggesting active residual cavernoma. Interestingly, her complaints gradually disappeared, and she is currently asymptomatic. MR after 3.5 years shows minimal cord swelling no longer suggesting active residual cavernoma.

Conclusion: With adequate surgical treatment either in the acute phase in case of dramatic deterioration or after clinical recuperation, prognosis of symptomatic ImC may be surprisingly good. However, subtotally resected lesions and/or syndromal cases may recur, requiring further treatment. Definitive answers await more cases with longer follow-up.

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Related in: MedlinePlus

a1–a3 Preoperative sagittal T1, T2, and axial T2 MR images revealing a markedly swollen cord, including hematomyelia at C4–C6 and a left anterolateral ImC at C5; b1, b2 3 months postoperative sagittal T2 and axial T2 FFE (fast field echo) MR images, note multiple small cerebral cavernomas; c1, c2 2.5 years postoperative sagittal and axial T2 MR images, the cord still appears swollen; d1, d2 3.5 years postoperative sagittal and axial T2 MR images, the cord now appears less swollen and the child is asymptomatic
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Fig2: a1–a3 Preoperative sagittal T1, T2, and axial T2 MR images revealing a markedly swollen cord, including hematomyelia at C4–C6 and a left anterolateral ImC at C5; b1, b2 3 months postoperative sagittal T2 and axial T2 FFE (fast field echo) MR images, note multiple small cerebral cavernomas; c1, c2 2.5 years postoperative sagittal and axial T2 MR images, the cord still appears swollen; d1, d2 3.5 years postoperative sagittal and axial T2 MR images, the cord now appears less swollen and the child is asymptomatic

Mentions: One day after a fall during skating, a 7-year-old girl suddenly developed cervicalgia and severe paresis of her left arm and leg (grades 1–2 out of 5 according to the American Spinal Injury Association). MR demonstrated hematomyelia at C4–C6 and an ImC at C5 (Fig. 2a). Within the next 10 days, her paresis improved to a grade 4, and at 3 months, her residual deficit was minimal.Fig. 2


Intramedullary cavernoma presenting with hematomyelia: report of two girls.

Cornips EM, Vinken PA, Ter Laak-Poort M, Beuls EA, Weber J, Vles JS - Childs Nerv Syst (2009)

a1–a3 Preoperative sagittal T1, T2, and axial T2 MR images revealing a markedly swollen cord, including hematomyelia at C4–C6 and a left anterolateral ImC at C5; b1, b2 3 months postoperative sagittal T2 and axial T2 FFE (fast field echo) MR images, note multiple small cerebral cavernomas; c1, c2 2.5 years postoperative sagittal and axial T2 MR images, the cord still appears swollen; d1, d2 3.5 years postoperative sagittal and axial T2 MR images, the cord now appears less swollen and the child is asymptomatic
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2821515&req=5

Fig2: a1–a3 Preoperative sagittal T1, T2, and axial T2 MR images revealing a markedly swollen cord, including hematomyelia at C4–C6 and a left anterolateral ImC at C5; b1, b2 3 months postoperative sagittal T2 and axial T2 FFE (fast field echo) MR images, note multiple small cerebral cavernomas; c1, c2 2.5 years postoperative sagittal and axial T2 MR images, the cord still appears swollen; d1, d2 3.5 years postoperative sagittal and axial T2 MR images, the cord now appears less swollen and the child is asymptomatic
Mentions: One day after a fall during skating, a 7-year-old girl suddenly developed cervicalgia and severe paresis of her left arm and leg (grades 1–2 out of 5 according to the American Spinal Injury Association). MR demonstrated hematomyelia at C4–C6 and an ImC at C5 (Fig. 2a). Within the next 10 days, her paresis improved to a grade 4, and at 3 months, her residual deficit was minimal.Fig. 2

Bottom Line: MR after 3.5 years shows minimal cord swelling no longer suggesting active residual cavernoma.However, subtotally resected lesions and/or syndromal cases may recur, requiring further treatment.Definitive answers await more cases with longer follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. e.cornips@mumc.nl

ABSTRACT

Introduction: Less than 20 children with intramedullary cavernoma (ImC) have been reported in the English literature; however, cases with an unfavorable outcome may be underreported. Whereas these are predominantly boys, we report two girls who presented with hematomyelia (one cervical, one thoracic) and an acute, severe neurological deficit.

Case material: A 10-year-old girl complaining about lower thoracic pain for several days suddenly developed lower body dysesthesias and paraparesis. Magnetic resonance (MR) demonstrated hematomyelia (T8-T11), intramedullary edema (T6-L1), and an ImC at T9-T10. Within an hour, she progressed to paraplegia and was therefore operated immediately. She slowly recovered regaining independent ambulation and continence. MR after 2 years shows no recurrence. A 7-year-old girl suddenly developed cervicalgia and paresis of her left arm and leg. MR demonstrated hematomyelia and an ImC at C4-C6. She gradually recovered with minimal residual deficit at 3 months and was subsequently operated uneventfully. Multiple cerebral cavernomas and a familial autosomal cavernous malformation syndrome were diagnosed. The following 1.5 years, she complained of intermittent cervicalgia and left brachial dysesthesias, with MR suggesting active residual cavernoma. Interestingly, her complaints gradually disappeared, and she is currently asymptomatic. MR after 3.5 years shows minimal cord swelling no longer suggesting active residual cavernoma.

Conclusion: With adequate surgical treatment either in the acute phase in case of dramatic deterioration or after clinical recuperation, prognosis of symptomatic ImC may be surprisingly good. However, subtotally resected lesions and/or syndromal cases may recur, requiring further treatment. Definitive answers await more cases with longer follow-up.

Show MeSH
Related in: MedlinePlus