We present a rare case of spontaneous hemorrhage of a spinal ependymoma in the filum terminale presenting with acute cauda equina syndrome. A 16-year-old male presented with a sudden onset of severe back pain that began 10 days before hospitalization. This symptom progressed, followed by development of decreased sensation in the lower extremities, bladder dysfunction, and motor weakness that advanced to an inability to walk. Spinal magnetic resonance imaging revealed a hemorrhagic mass from Th12 to L2 and L4 to L5, and clinical signs indicated acute cauda equina compression. One day after admission to the hospital, emergency surgery was performed. A spinal tumor in the conus portion with a spinal subarachnoid hemorrhage was seen. Gross total excision of the massive hematoma mixed with the underlying tumor was performed. Pathological findings of the excised tumor demonstrated a WHO Grade II cellular ependymoma of the non-myxopapillary type. The patient made a significant recovery. The ability to walk was restored, and impaired bladder function improved at follow-up. Early diagnosis and suitable treatment are associated with a more favorable outcome.
Objective: To evaluate the relationship between the incidence of the CT high-density area that appears immediately after endovascular treatment for acute ischemic stroke with postprocedural hemorrhagic transformation and its significance in the clinical outcome.Methods: Ten patients with ischemic stroke of the anterior circulation encountered between May 2014 and December 2015 in whom recanalization could be achieved within 8 hours after the onset were retrospectively analyzed. In addition, 695 patients presented in 13 reports were divided into thrombolysis and mechanical thrombectomy groups, and the postprocedural incidence of CT high-density areas was compared between the two groups.Results: Postprocedural CT high-density areas were observed in six (60%) of our patients. Hemorrhagic transformation occurred in three of them, but no exacerbation of neurological symptoms was noted. The incidence of postprocedural CT high-density areas was 43.1% (191/443) in the thrombolysis group and 71.8% (188/262) in the mechanical thrombectomy group including our patients, being significantly higher in the latter group (p <0.01).
Conclusion:Although CT high-density areas appear more frequently after mechanical thrombectomy than after thrombolysis, they are considered to be infrequently developed into hemorrhagic transformation and exert relatively few negative effects on the neurological outcome.
A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy.
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