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Spinal myxopapillary ependymoma in an adult male presenting with recurrent acute low back pain: a case report.

Petersen D, Lystad RP - Chiropr Man Therap (2016)

Bottom Line: The mean duration of symptoms is 40 months until the lesion is diagnosed.Although the first episode of LBP was resolved, the clinical examination during the second episode revealed subtle changes that warranted referral to magnetic resonance imaging (MRI).The MRI revealed a spinal myxopapillary ependymoma.

View Article: PubMed Central - PubMed

Affiliation: Private practice, Mackay, QLD Australia.

ABSTRACT

Background: Spinal intramedullary ependymomas are very rare and occur more commonly in the cervical and upper thoracic regions. These neoplasms tend to manifest in young adulthood, and patients typically present with mild clinical symptoms without objective evidence of neurologic deficits. The mean duration of symptoms is 40 months until the lesion is diagnosed.

Case presentation: A 48-year-old male police officer was referred to a chiropractic clinic by a general practitioner for the evaluation of recurrent acute low back pain (LBP). Although the first episode of LBP was resolved, the clinical examination during the second episode revealed subtle changes that warranted referral to magnetic resonance imaging (MRI). The MRI revealed a spinal myxopapillary ependymoma.

Conclusion: Because the primary symptoms of spinal intramedullary ependymomas can mimic ordinary LBP presentations, in particular lumbar intervertebral disc herniations, clinicians need to be sensitive to subtle changes in the clinical presentation of LBP patients. Prompt referral to advanced medical imaging such as MRI and early neurosurgical intervention is key to achieve best possible outcomes for patients with spinal intramedullary ependymomas.

No MeSH data available.


Related in: MedlinePlus

Sagittal fat suppressed T1-weighted (a) and T2-weighted (b) magnetic resonance images of the lumbosacral spine. A heterogeneous, predominantly cystic, intramedullary space-occupying lesion measuring 2.5 × 1.2 cm is present within the filum terminale at L2/3 level (green arrow). Additional findings include a transitional lumbosacral vertebra (lumbarisation of S1), dehydration of the L5/S1 intervertebral disc with a posterior disc bulge, and a hemangioma in the vertebral body of L5. The remainder of the spinal cord and conus medullaris, lower thoracic and lumbosacral vertebrae, intervertebral disc spaces, and paraspinal soft tissues appear normal
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Fig1: Sagittal fat suppressed T1-weighted (a) and T2-weighted (b) magnetic resonance images of the lumbosacral spine. A heterogeneous, predominantly cystic, intramedullary space-occupying lesion measuring 2.5 × 1.2 cm is present within the filum terminale at L2/3 level (green arrow). Additional findings include a transitional lumbosacral vertebra (lumbarisation of S1), dehydration of the L5/S1 intervertebral disc with a posterior disc bulge, and a hemangioma in the vertebral body of L5. The remainder of the spinal cord and conus medullaris, lower thoracic and lumbosacral vertebrae, intervertebral disc spaces, and paraspinal soft tissues appear normal

Mentions: The MRI revealed a substantial heterogeneous space-occupying lesion with an intramedullary orientation within the filum terminale at the L2/3 vertebral level (see Fig. 1). The lesion measured approximately 2.5 cm × 1.2 cm in the craniocaudal and anterior-posterior dimensions, respectively. It appeared predominantly cystic on T2-weighted sequences and contained several fine internal septations. On post-contrast imaging, there was a heterogeneous enhancement of the lesion (predominantly peripheral), with a non-enhancing central aspect indicating a possible haemorrhagic or calcific component. The remainder of the spinal cord and conus medullaris appeared normal. Because the observed lesion most likely represented a myxoapapillary ependymoma, the patient was promptly referred for a neurosurgical consultation. Fig. 1


Spinal myxopapillary ependymoma in an adult male presenting with recurrent acute low back pain: a case report.

Petersen D, Lystad RP - Chiropr Man Therap (2016)

Sagittal fat suppressed T1-weighted (a) and T2-weighted (b) magnetic resonance images of the lumbosacral spine. A heterogeneous, predominantly cystic, intramedullary space-occupying lesion measuring 2.5 × 1.2 cm is present within the filum terminale at L2/3 level (green arrow). Additional findings include a transitional lumbosacral vertebra (lumbarisation of S1), dehydration of the L5/S1 intervertebral disc with a posterior disc bulge, and a hemangioma in the vertebral body of L5. The remainder of the spinal cord and conus medullaris, lower thoracic and lumbosacral vertebrae, intervertebral disc spaces, and paraspinal soft tissues appear normal
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4834819&req=5

Fig1: Sagittal fat suppressed T1-weighted (a) and T2-weighted (b) magnetic resonance images of the lumbosacral spine. A heterogeneous, predominantly cystic, intramedullary space-occupying lesion measuring 2.5 × 1.2 cm is present within the filum terminale at L2/3 level (green arrow). Additional findings include a transitional lumbosacral vertebra (lumbarisation of S1), dehydration of the L5/S1 intervertebral disc with a posterior disc bulge, and a hemangioma in the vertebral body of L5. The remainder of the spinal cord and conus medullaris, lower thoracic and lumbosacral vertebrae, intervertebral disc spaces, and paraspinal soft tissues appear normal
Mentions: The MRI revealed a substantial heterogeneous space-occupying lesion with an intramedullary orientation within the filum terminale at the L2/3 vertebral level (see Fig. 1). The lesion measured approximately 2.5 cm × 1.2 cm in the craniocaudal and anterior-posterior dimensions, respectively. It appeared predominantly cystic on T2-weighted sequences and contained several fine internal septations. On post-contrast imaging, there was a heterogeneous enhancement of the lesion (predominantly peripheral), with a non-enhancing central aspect indicating a possible haemorrhagic or calcific component. The remainder of the spinal cord and conus medullaris appeared normal. Because the observed lesion most likely represented a myxoapapillary ependymoma, the patient was promptly referred for a neurosurgical consultation. Fig. 1

Bottom Line: The mean duration of symptoms is 40 months until the lesion is diagnosed.Although the first episode of LBP was resolved, the clinical examination during the second episode revealed subtle changes that warranted referral to magnetic resonance imaging (MRI).The MRI revealed a spinal myxopapillary ependymoma.

View Article: PubMed Central - PubMed

Affiliation: Private practice, Mackay, QLD Australia.

ABSTRACT

Background: Spinal intramedullary ependymomas are very rare and occur more commonly in the cervical and upper thoracic regions. These neoplasms tend to manifest in young adulthood, and patients typically present with mild clinical symptoms without objective evidence of neurologic deficits. The mean duration of symptoms is 40 months until the lesion is diagnosed.

Case presentation: A 48-year-old male police officer was referred to a chiropractic clinic by a general practitioner for the evaluation of recurrent acute low back pain (LBP). Although the first episode of LBP was resolved, the clinical examination during the second episode revealed subtle changes that warranted referral to magnetic resonance imaging (MRI). The MRI revealed a spinal myxopapillary ependymoma.

Conclusion: Because the primary symptoms of spinal intramedullary ependymomas can mimic ordinary LBP presentations, in particular lumbar intervertebral disc herniations, clinicians need to be sensitive to subtle changes in the clinical presentation of LBP patients. Prompt referral to advanced medical imaging such as MRI and early neurosurgical intervention is key to achieve best possible outcomes for patients with spinal intramedullary ependymomas.

No MeSH data available.


Related in: MedlinePlus