A 34-year-old Caucasian woman was admitted complaining of a 10-day history of acute thoracic pain, progressive weakness of both lower extremities, worse on the right side, a 'pins and needles' sensation in the abdominal region, and bladder dysfunction. A neurological examination revealed spastic paraparesis, symmetrically decreased lower-extremity reflexes in her legs, a bilateral positive Babinski sign and decreased pinprick sensation below D6 level.
Our patient underwent an MRI scan of the spine, which revealed an intramedullary lesion at D5 level with high-intensity signal relative to the spinal cord on T1-weighted images, spindle-like shaped and 1.5cm in diameter (Figure 1). An MRI scan with angiographic sequences and selective spinal angiography did not show vascular blush or abnormal vascularity.
T1-weighted sagittal magnetic resonance image showing a high signal intensity mass at D5 level.
Our patient underwent D4-D5-D6 laminectomy. At the operation, the dura appeared intact. Once exposed, the spinal cord appeared normal on the surface although it was swollen at D5 level. A midline cordotomy was performed and a well-circumscribed dark-bluish lesion, measuring 1.5×0.5cm in diameter, was revealed deep within the spinal cord (Figure 2a). The lesion was carefully dissected out and totally removed in one piece (Figure 2b). A histological examination revealed the typical features of a cavernous angioma.
Intraoperative photograph revealing an intramedullary lesion after myelotomy (a); the lesion was carefully dissected out and removed in one piece (b).
The immediate postoperative course was uneventful. The paraparesis and sensory deficits gradually improved and our patient was discharged on the 18th postoperative day. A one-month follow-up spine MRI scan revealed no residual lesion (Figure 3). One-year post-operatively, our patient was able to walk again.
T1-weighted sagittal magnetic resonance image one month later, showing no evidence of residual lesion.
J Med Case Reports. 2014;8(271) © 2014 BioMed Central, Ltd.