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Thoracic Nerve Root Schwannoma Filling the Spinal Canal Almost Entirely Without any Neurological Deficits.

Godlewski B, Klauz G, Czepko R - Anesth Pain Med (2016)

Bottom Line: A histological examination confirmed a benign schwannoma lesion (WHO G1).Appropriate imaging studies, even in patients presenting with no neurological deficits, may help detect pathologies than can lead to severe disability.A spinal canal tumour filling the spinal canal almost entirely and displacing the spinal cord could cause spinal cord damage at any time with all the dire consequences such as paraplegia and loss of the ability to walk.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Scanmed-St. Raphael Hospital, Cracow, Poland.

ABSTRACT

Introduction: Spinal tumours may be classified in three groups: 1) extradural, 2) intradural extramedullary and 3) intramedullary spinal cord tumours. Intradural extramedullary tumours arise from the leptomeninges or nerve roots and include schwannomas. A schwannoma is usually a firm grey-whitish tumour growing near a nerve trunk or ramus. It can be separated from the nerve without damaging neural tissue. Schwannomas are usually solitary tumours.

Case presentation: We present the case of a 37-year-old male who underwent surgery for a tumour in the upper thoracic segment of the spinal canal. Although the tumour filled the spinal canal almost entirely, the patient did not manifest any neurological deficits. During the surgery, the tumour was removed completely. A histological examination confirmed a benign schwannoma lesion (WHO G1).

Conclusions: The question whether doctors are keen to order more diagnostic investigations (including both laboratory and imaging studies) than are necessary is often asked in clinical practice. The cost factor is also important. Not every patient with back pain is referred for an MRI study in the absence of characteristic neurological signs. The case of our patient, however, speaks in favour of early referral for such diagnostic modalities. Appropriate imaging studies, even in patients presenting with no neurological deficits, may help detect pathologies than can lead to severe disability. A spinal canal tumour filling the spinal canal almost entirely and displacing the spinal cord could cause spinal cord damage at any time with all the dire consequences such as paraplegia and loss of the ability to walk.

No MeSH data available.


Related in: MedlinePlus

An MR Image of the Spine Showing a Spinal Tumour at Th1-Th2The transverse view reveals that the tumour fills the spinal canal almost entirely and causes a critical displacement of the spinal cord to the right.
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fig26787: An MR Image of the Spine Showing a Spinal Tumour at Th1-Th2The transverse view reveals that the tumour fills the spinal canal almost entirely and causes a critical displacement of the spinal cord to the right.

Mentions: A 37-year-old male patient presented for a neurosurgical consultation complaining of intermittent non-specific pain in the thoracic spine. A neurological examination revealed no neurological deficits. The patient ambulated smoothly and unassisted, there was no weakness of lower limb muscles and no signs of compression of the spinal cord such as spastic paresis, pronounced lower limb reflexes, clonuses at the ankle or patella, extensor plantar response, left-right reflex asymmetry or sensory loss. The back pain had initially prompted the patient to contact his rehabilitation specialist and attend several sessions of rehabilitation and manual therapy. However, as the symptoms persisted, he came for a consultation with a neurosurgeon “just in case”, as he said. The patient reported back pain localized in upper thoracic level of the spine with a slight left-sided laterality of symptoms. Despite the finding of no neurological deficits, the patient was referred for an MRI examination of the thoracic spine. Two weeks later, the patient came back with his MRI report revealing a lesion consistent with a spinal canal tumour at Th1-Th2. The tumour was extramedullary, partly extra- and partly intradural. It was noted that the tumour filled the spinal canal almost entirely, causing critical compression and right displacement of the spinal canal (Figure 1).


Thoracic Nerve Root Schwannoma Filling the Spinal Canal Almost Entirely Without any Neurological Deficits.

Godlewski B, Klauz G, Czepko R - Anesth Pain Med (2016)

An MR Image of the Spine Showing a Spinal Tumour at Th1-Th2The transverse view reveals that the tumour fills the spinal canal almost entirely and causes a critical displacement of the spinal cord to the right.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834741&req=5

fig26787: An MR Image of the Spine Showing a Spinal Tumour at Th1-Th2The transverse view reveals that the tumour fills the spinal canal almost entirely and causes a critical displacement of the spinal cord to the right.
Mentions: A 37-year-old male patient presented for a neurosurgical consultation complaining of intermittent non-specific pain in the thoracic spine. A neurological examination revealed no neurological deficits. The patient ambulated smoothly and unassisted, there was no weakness of lower limb muscles and no signs of compression of the spinal cord such as spastic paresis, pronounced lower limb reflexes, clonuses at the ankle or patella, extensor plantar response, left-right reflex asymmetry or sensory loss. The back pain had initially prompted the patient to contact his rehabilitation specialist and attend several sessions of rehabilitation and manual therapy. However, as the symptoms persisted, he came for a consultation with a neurosurgeon “just in case”, as he said. The patient reported back pain localized in upper thoracic level of the spine with a slight left-sided laterality of symptoms. Despite the finding of no neurological deficits, the patient was referred for an MRI examination of the thoracic spine. Two weeks later, the patient came back with his MRI report revealing a lesion consistent with a spinal canal tumour at Th1-Th2. The tumour was extramedullary, partly extra- and partly intradural. It was noted that the tumour filled the spinal canal almost entirely, causing critical compression and right displacement of the spinal canal (Figure 1).

Bottom Line: A histological examination confirmed a benign schwannoma lesion (WHO G1).Appropriate imaging studies, even in patients presenting with no neurological deficits, may help detect pathologies than can lead to severe disability.A spinal canal tumour filling the spinal canal almost entirely and displacing the spinal cord could cause spinal cord damage at any time with all the dire consequences such as paraplegia and loss of the ability to walk.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Scanmed-St. Raphael Hospital, Cracow, Poland.

ABSTRACT

Introduction: Spinal tumours may be classified in three groups: 1) extradural, 2) intradural extramedullary and 3) intramedullary spinal cord tumours. Intradural extramedullary tumours arise from the leptomeninges or nerve roots and include schwannomas. A schwannoma is usually a firm grey-whitish tumour growing near a nerve trunk or ramus. It can be separated from the nerve without damaging neural tissue. Schwannomas are usually solitary tumours.

Case presentation: We present the case of a 37-year-old male who underwent surgery for a tumour in the upper thoracic segment of the spinal canal. Although the tumour filled the spinal canal almost entirely, the patient did not manifest any neurological deficits. During the surgery, the tumour was removed completely. A histological examination confirmed a benign schwannoma lesion (WHO G1).

Conclusions: The question whether doctors are keen to order more diagnostic investigations (including both laboratory and imaging studies) than are necessary is often asked in clinical practice. The cost factor is also important. Not every patient with back pain is referred for an MRI study in the absence of characteristic neurological signs. The case of our patient, however, speaks in favour of early referral for such diagnostic modalities. Appropriate imaging studies, even in patients presenting with no neurological deficits, may help detect pathologies than can lead to severe disability. A spinal canal tumour filling the spinal canal almost entirely and displacing the spinal cord could cause spinal cord damage at any time with all the dire consequences such as paraplegia and loss of the ability to walk.

No MeSH data available.


Related in: MedlinePlus