An unusual case of recurrent subarachnoid haemorrhage caused by a benign neurinoma in the region of the cauda equina is reported, in which the tumour was supplied by an accessory dilated artery. After recurrent complaints in the lumbar region an acute cerebral symptomatology first led to the diagnosis of a subarachnoid haemorrhage of unknown aetiology. It was only the recurrence of the bleeding which enabled the tumour to be detected. Other cases from the literature of subarachnoid haemorrhage due to spinal tumours are considered and the mechanism of bleeding and diagnostic problems are discussed.
During 1 year 6 patients with dislocated fractures of C-1 and C-2 vertebrae (fractures of the odontoid process) and 1 patient with a pseudarthrosis of the odontoid process have been treated. 6 patients have been treated surgically by internal fixation of the arch of C-1 and C-2 spinous process by wiring and plastic material (Palacos). No complications occurred. The advantage of the method was early mobilization of the patients and reduction of hospitalization. Clinical and radiographic follow-up studies showed stable fusion on Flexion-extension X-rays and boney union of the fracture of the odontoid process.
Computerized tomography scans of 166 patients - 99 cases with 117 aneurysms, and 67 cases with angiomatous malformations - were reviewed and correlated with angiographic and clinical findings. An intracranial hemorrhage was identified by CT scan in 103 patients, in 60 cases with aneurysms (17 only subarachnoid, 43 intracerebral), and in 43 cases with angiomas (6 only subarachnoid, 37 intracerebral). The source of hemorrhage was diagnosed with varying degrees of certainty with CT scan in 12 (12%) cases with aneurysms and in 27 (40%) cases with angiomas. Further CT findings were low density lesions in 18 cases indicating vasogenic edma, and calcifications in 10 angiomas. Intravenous infusion of contrast material was necessary to distinguish smaller aneurysms and angiomas. CT scan demonstrated the presence and location of thrombosed portions of giant aneurysms; these findings were less apparent with angiography. In 29 angiomas of medium or large size (macroangiomas) the malformation was demonstrated with CT scan in 25 (86%) cases and with angiography in 26 cases. 3 angiographically occult angiomas were diagnosed with CT as low density lesions and misinterpreted as gliomas. In all 36 microangiomas only the hemorrhage was precisely diagnosed with CT. The microangioma was identified angiographically in 24 cases and histologically in 21. In Sturge-Weber's disease the calcifications may be seen earlier with CT than with skull x-ray.
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