Thoracic Spinal Cord Cavernous Angioma: A Case Report and Review of the Literature

Giovanni Grasso; Concetta Alafaci; Francesca Granata; Mariano Cutugno; Francesco Maria Salpietro; Francesco Tomasello

Disclosures

J Med Case Reports. 2014;8(271) 

In This Article

Abstract and Introduction

Abstract

Introduction: Cavernous angiomas of the spinal cord are rare vascular malformations, which account for approximately 5 to 12 percent of spinal cord vascular lesions. They usually originate in the vertebrae, with occasional extension into the extradural space, and intramedullary cavernomas, even if reported in the literature, are very rare.

Case presentation: We report the case of a 34-year-old Caucasian woman affected by a thoracic intramedullary cavernous angioma. Our patient complained of 10-day history of acute dorsal pain, progressive weakness of both lower extremities, worse on the right side, a 'pins and needles' sensation in the abdominal region and bladder dysfunction. Magnetic resonance imaging showed, at D5 level, a vascular malformation, which was not documented at spinal angiography. Our patient underwent surgical treatment with total removal of the lesion and her symptoms gradually improved. A histological examination revealed the typical features of a cavernous angioma.

Conclusions: Intramedullary cavernous angioma is a rare lesion that should be diagnosed early and surgically treated before rebleeding or enlargement of the lesion can occur.

Introduction

Cavernous angiomas are uncommon vascular malformations of the central nervous system (CNS) characterized by abnormally dilated blood vessels, lined by a thin endothelium without intervening normal nervous tissue. They are more common in women and tend to become clinically symptomatic during the third and the fourth decade of life.[1] In the spine, cavernous angiomas represent 5 to 12 percent of spinal cord vascular lesions and they frequently originate in the vertebrae with occasional extension into the extradural space.[1] Intramedullary cavernomas are very rare. They are usually solitary although may be associated with cavernous angiomas in other organs or in the central nervous system.[2] The most common clinical presentation is represented by a slowly progressive myelopathy, but subarachnoid hemorrhage[3] and hematomyelia[4] have also been described.

Since the advent of magnetic resonance imaging (MRI), large series of these relatively rare lesions have been reported with increasing frequency, allowing a better understanding about epidemiology, natural history, clinical presentation, and surgical results.[5–12]

Here, the authors describe the clinical, neuroradiological, and surgical features of a new case of intramedullary cavernous angioma in the thoracic spinal cord.

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