Brown-Séquard Syndrome Secondary to Spontaneous Bleed from Postradiation Cavernous Angiomas: Fig 1.

Mathews, Marlon S.; Peck, Wallace W.; Brant‐Zawadzki, Michael

doi:10.3174/ajnr.a1158

Cited by 14 publications

(11 citation statements)

References 3 publications

(4 reference statements)

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“…A spinal CM developed at the irradiation field 8 years later. The fourth case was reported by Mathews et al 12) in 2008. A 27-year-old man presented with acute Brown-Sequard syndrome.…”

Section: Discussionmentioning

confidence: 87%

Delayed Diagnosis of Probable Radiation Induced Spinal Cord Vascular Disorders

Won

Kim

Chung

et al. 2015

J Korean Neurosurg Soc

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Occasionally, unexpected neurological deficits occur after lumbar spinal surgery. We report a case of monoparesis after lumbar decompressive surgery. A 63-year-old man, who had undergone decompression of L4-5 for spinal stenosis 4 days previously in the other hospital, visted the emergency department with progressive weakness in the left leg and hypoesthesia below sensory level T7 on the right side. He had been cured of lung cancer with chemotherapy and radiation therapy 10 years previously, but detailed information of radiotherapy was not available. Whole spine magnetic resonance (MR) imaging showed fatty marrow change from T1 to T8, most likely due to previous irradiation. The T2-weighted MR image showed a high-signal T4-5 spinal cord lesion surrounded by a low signal rim, and the T1-weighted MR image showed focal high signal intensity with focal enhancement. The radiological diagnosis was vascular disorders with suspicious bleeding. Surgical removal was refused by the patient. With rehabilitation, the patient could walk independently without assistance 2 months later. Considering radiation induced change at thoracic vertebrae, vascular disorders may be induced by irradiation. If the spinal cord was previously irradiated, radiation induced vascular disorders needs to be considered.

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“…A spinal CM developed at the irradiation field 8 years later. The fourth case was reported by Mathews et al 12) in 2008. A 27-year-old man presented with acute Brown-Sequard syndrome.…”

Section: Discussionmentioning

confidence: 87%

Delayed Diagnosis of Probable Radiation Induced Spinal Cord Vascular Disorders

Won

Kim

Chung

et al. 2015

J Korean Neurosurg Soc

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“…A survey of the literature revealed six cases of intraspinal RICHs (Table 1). [13][14][15][16][17][18] All patients except one underwent radiation at age less than 18 years and developed intraspinal RICHs 5-29 years after irradiation, which is comparable to cerebral RICHs. 4,6,7 Three evaluable patients received 27 Gy or higher radiation doses to the spinal cord, whereas the present patient developed spinal hemorrhage from a RICH after receiving TBI 12 Gy.…”

Section: Discussionmentioning

confidence: 87%

“…The reason why intraspinal RICHs are less frequent than cerebral RICHs is not clear, but one possible reason might be that the volume of spinal cord is much smaller than that of brain, approximately one 50th of brain volume, so the incidence of RICHs could be stochastically decreased. A survey of the literature revealed six cases of intraspinal RICHs (Table ) . All patients except one underwent radiation at age less than 18 years and developed intraspinal RICHs 5–29 years after irradiation, which is comparable to cerebral RICHs .…”

Section: Discussionmentioning

confidence: 98%

Sudden spinal hemorrhage in a pediatric case with total body irradiation‐induced cavernous hemangioma

Mikami

Kato

Nozaki

et al. 2018

Pediatric Blood & Cancer

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Compared to cerebral radiation-induced cavernous hemangiomas (RICHs), little is known about intraspinal RICHs. A 13-year-old male suddenly developed symptomatic spinal hemorrhage eight years after hematopoietic stem cell transplantation using a total body irradiation (TBI) based myeloablative regimen. A solitary small hemangioma was detected on follow-up T2 star weighted magnetic resonance imaging of the spine. His neurological symptoms gradually improved with supportive treatment and rehabilitation, although he experienced rebleeding 2 years later. Intraspinal RICH is very rare but should be recognized as a possible late adverse effect in pediatric patients who received TBI.

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“…Thrombotic venous occlusion, compression of draining vessels, or sudden rupture of the amuscular wall with extralesional hematoma can lead to an acute increase in volume and sudden onset of clinical symptoms. Nevertheless, rapid clinical deterioration including sudden para-or tetraparesis generally is a rare event and usually caused by massive bleeding and compressive epidural hematoma [5,[7][8][9] or even intramedullary hematoma [4]. The typical clinical characteristics and imaging features of PSECAs have been evaluated by Aoyagi et al [2] in review comprising a large series of 54 cases published between 1932 and 2001.…”

Section: Discussionmentioning

confidence: 99%

Intralesional hemorrhage and thrombosis without rupture in a pure spinal epidural cavernous angioma: a rare cause of acute lumbal radiculopathy

2010

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Pure spinal epidural cavernous angiomas are extremely rare lesions, and their normal shape is that of a fusiform mass in the dorsal aspects of the spinal canal. We report a case of a lumbo-sacral epidural cavernous vascular malformation presenting with acute onset of right-sided S1 radiculopathy. Clinical aspects, imaging, intraoperative findings, and histology are demonstrated. The patient, a 27-year-old man presented with acute onset of pain, paraesthesia, and numbness within the right leg corresponding to the S1 segment. An acute lumbosacral disc herniation was suspected, but MRI revealed a cystic lesion with the shape of a balloon, a fluid level and a thickened contrast-enhancing wall. Intraoperatively, a purple-blue tumor with fibrous adhesions was located between the right S1 and S2 nerve roots. Macroscopically, no signs of epidural bleedings could be denoted. After coagulation of a reticular venous feeder network and dissection of the adhesions the rubber ball-like lesion was resected in total. Histology revealed a prominent venous vessel with a pathologically thickened, amuscular wall surrounded by smaller, hyalinized, venous vessels arranged in a back-to-back position typical for the diagnosis of a cavernous angioma. Lumina were partially occluded by thrombi. The surrounding fibrotic tissue showed signs of recurrent bleedings. There was no obvious mass hemorrhage into the surrounding tissue. In this unique case, the pathologic mechanism was not the usual rupture of the cavernous angioma with subsequent intraspinal hemorrhage, but acute mass effect by intralesional bleedings and thrombosis with subsequent increase of volume leading to nerve root compression. Thus, even without a sudden intraspinal hemorrhage a spinal cavernous malformation can cause acute symptoms identical to the clinical features of a soft disc herniation.

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Brown-Séquard Syndrome Secondary to Spontaneous Bleed from Postradiation Cavernous Angiomas: Fig 1.

Cited by 14 publications

References 3 publications

Delayed Diagnosis of Probable Radiation Induced Spinal Cord Vascular Disorders

Delayed Diagnosis of Probable Radiation Induced Spinal Cord Vascular Disorders

Sudden spinal hemorrhage in a pediatric case with total body irradiation‐induced cavernous hemangioma

Intralesional hemorrhage and thrombosis without rupture in a pure spinal epidural cavernous angioma: a rare cause of acute lumbal radiculopathy

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