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Cobb syndrome: A rare cause of paraplegia.

Pal P, Ray S, Chakraborty S, Dey S, Talukdar A - Ann Neurosci (2015)

Bottom Line: These concurrent findings led to the diagnosis of Cobb's syndrome.Cobb's syndrome is a rare disease entity and literature search revealed only a few case reports and series mentioning this condition to date.The importance lies in the recognition that cutaneous vascular lesions may clue to an associated spinal cord angioma or AVM that may lead to weakness or paralysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Calcutta National Medical College and Hospital, Kolkata.

ABSTRACT
Cobb syndrome is an exceedingly rare clinical condition defined by the presence of a vascular skin nevus and an angioma in the spinal canal at the same metamere. We report the case of a 14-year-old boy who presented with sudden onset paraplegia. Physical examination showed port-wine stains over buttock and thigh. Magnetic resonance (MR) angiogram of the dorso-lumbar spine revealed a large arteriovenous malformation (AVM) at D11-D12 to L2-L3 levels. These concurrent findings led to the diagnosis of Cobb's syndrome. The patient received orally administered prednisolone therapy and underwent endovascular embolization of spinal angioma. Cobb's syndrome is a rare disease entity and literature search revealed only a few case reports and series mentioning this condition to date. The importance lies in the recognition that cutaneous vascular lesions may clue to an associated spinal cord angioma or AVM that may lead to weakness or paralysis.

No MeSH data available.


Related in: MedlinePlus

(A). MR angiogram (MIP image) showing a dilated and tortuous feeding artery of the AVM arising from lower intercostal arteries (yellow arrow); (B). Axial fat-suppressed post-contrast T1 weighted image showing multiple intra thecal dilated vessels (yellow arrow) situated both dorsal and ventral to the cauda and conus.
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fig_3: (A). MR angiogram (MIP image) showing a dilated and tortuous feeding artery of the AVM arising from lower intercostal arteries (yellow arrow); (B). Axial fat-suppressed post-contrast T1 weighted image showing multiple intra thecal dilated vessels (yellow arrow) situated both dorsal and ventral to the cauda and conus.

Mentions: A lumbar puncture was performed in a guarded fashion in L4-L5 interspace as per our hospital protocol for investigation of paraplegia to exclude chronic infections which revealed xanthochromic cerebrospinal fluid (CSF) with cells 8/mm3 (all lymphocytes). Protein and glucose levels were 440 mg/dl and 40 mg/dl respectively. The lumbar puncture could have been avoided if we had the magnetic resonance imaging (MRI) of dorso-lumbar spine findings available with us beforehand. It revealed a large arteriovenous malformation (AVM). The AVM was extending from D11-D12 to L2-L3 levels (Figure 2) with associated hematomyelia in the lower dorsal cord and hematoma in the conus with low lying conus terminating at L3. A dilated and tortuous vessel was seen arising from one of the right sided intercostal artery and going into the dorsal spinal canal through the right sided neural foramina (Figure 3A). Intrathecal enhancing vessels were seen on post contrast T1W images (Figure 3B).


Cobb syndrome: A rare cause of paraplegia.

Pal P, Ray S, Chakraborty S, Dey S, Talukdar A - Ann Neurosci (2015)

(A). MR angiogram (MIP image) showing a dilated and tortuous feeding artery of the AVM arising from lower intercostal arteries (yellow arrow); (B). Axial fat-suppressed post-contrast T1 weighted image showing multiple intra thecal dilated vessels (yellow arrow) situated both dorsal and ventral to the cauda and conus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4481555&req=5

fig_3: (A). MR angiogram (MIP image) showing a dilated and tortuous feeding artery of the AVM arising from lower intercostal arteries (yellow arrow); (B). Axial fat-suppressed post-contrast T1 weighted image showing multiple intra thecal dilated vessels (yellow arrow) situated both dorsal and ventral to the cauda and conus.
Mentions: A lumbar puncture was performed in a guarded fashion in L4-L5 interspace as per our hospital protocol for investigation of paraplegia to exclude chronic infections which revealed xanthochromic cerebrospinal fluid (CSF) with cells 8/mm3 (all lymphocytes). Protein and glucose levels were 440 mg/dl and 40 mg/dl respectively. The lumbar puncture could have been avoided if we had the magnetic resonance imaging (MRI) of dorso-lumbar spine findings available with us beforehand. It revealed a large arteriovenous malformation (AVM). The AVM was extending from D11-D12 to L2-L3 levels (Figure 2) with associated hematomyelia in the lower dorsal cord and hematoma in the conus with low lying conus terminating at L3. A dilated and tortuous vessel was seen arising from one of the right sided intercostal artery and going into the dorsal spinal canal through the right sided neural foramina (Figure 3A). Intrathecal enhancing vessels were seen on post contrast T1W images (Figure 3B).

Bottom Line: These concurrent findings led to the diagnosis of Cobb's syndrome.Cobb's syndrome is a rare disease entity and literature search revealed only a few case reports and series mentioning this condition to date.The importance lies in the recognition that cutaneous vascular lesions may clue to an associated spinal cord angioma or AVM that may lead to weakness or paralysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Calcutta National Medical College and Hospital, Kolkata.

ABSTRACT
Cobb syndrome is an exceedingly rare clinical condition defined by the presence of a vascular skin nevus and an angioma in the spinal canal at the same metamere. We report the case of a 14-year-old boy who presented with sudden onset paraplegia. Physical examination showed port-wine stains over buttock and thigh. Magnetic resonance (MR) angiogram of the dorso-lumbar spine revealed a large arteriovenous malformation (AVM) at D11-D12 to L2-L3 levels. These concurrent findings led to the diagnosis of Cobb's syndrome. The patient received orally administered prednisolone therapy and underwent endovascular embolization of spinal angioma. Cobb's syndrome is a rare disease entity and literature search revealed only a few case reports and series mentioning this condition to date. The importance lies in the recognition that cutaneous vascular lesions may clue to an associated spinal cord angioma or AVM that may lead to weakness or paralysis.

No MeSH data available.


Related in: MedlinePlus