Cervical C2 to C4 schwannoma with intratumoral hemorrhage presenting as acute spastic quadriparesis: A rare case report

Abstract

Background:Spinal schwannomas are slow growing, benign nerve sheath tumors. These may be asymptomatic or may present as backache with radicular pain, slowly progressive neurological deficits, but rarely with acute spastic quadriparesis attributed to intratumoral hemorrhage.Case Description:A 38-year-old male presented with the chief complaint of neck pain radiating to the left upper extremity for the last 8 months. On admission, he exhibited diffuse hyper-reflexia but had no motor or sensory deficit. Magnetic resonance imaging showed a solid-cystic intradural extramedullary (IDEM) C2 to C4 mass severely compressing the spinal cord. The same day the patient acutely developed a spastic quadriparesis. Immediately, a partial C2, C3, and C4 laminectomy was performed for tumor excision; within 5 postoperative days, he fully regained neurological function. The final histopathology was consistent with a “schwannoma showing areas of congestion and hemorrhage.”Conclusion:Spinal schwannomas rarely present with intratumoral hemorrhage and acute spastic quadriparesis. Immediate operative decompression may lead to excellent postoperative neurological recovery.

Acute Neurological Aggravation Caused by Intratumoral Hemorrhage of a Cervical Dumbbell Schwannoma: Report of a Rare Case and Literature Review

“…In our literature review, urgent tumor resection was performed as observed in nine reports [1,2,7,[10][11][12][13][14][15], elective surgery reported by two [4,16], with no record in another two [8,17] (Table 1). Complete recovery was achieved in five of nine patients who underwent urgent surgery, whereas four had neurological sequelae, such as ambulation with aid, no improvement in BBD and quadriplegia with respiratory paralysis [1,4,10].…”

Cervical schwannoma with acute worsening and intratumoral hemorrhage

“…[ Table 1 ]. [ 3 , 4 , 9 ] Patients presented with quadriparetic neurological deficits, variably accompanied by sensory and/ or sphincteric changes.…”

“…[ 7 , 10 ] Patients with acute intratumoral hemorrhages into cervical schwannomas may present with the rapid onset of pain, radiculopathy, and/or myelopathy warranting urgent/emergent resection and stabilization. [ 2 - 4 , 6 , 9 ]…”

Hemorrhagic Schwannoma of the Cauda Equina: Case Report and Review of the Literature

“…These hemorrhagic lesions affect almost equally the cervical spine (24%), 4 , 5 , 8 , 11 , 18 , 25 , 27) the lumbar tract (24%), 7 , 13 , 16 , 17 , 21 , 22 , 28) the thoracic tract (20%), 2 , 6 , 9 , 14 , 19 , 29) and the thoraco-lumbar passage (20%) 10 , 12 , 20 , 22 , 24 , 26) while the thoraco-cervical, 15) the sacral-lumbar tract, 30) and the sacral spine 23) are more rarely involved (12%). Bleeding can occur within the tumor (34%), 6 , 11 , 12 , 17 , 22 , 25 , 26 , 27 , 28 , 30) between the inner layer of the dura mater and the arachnoid mater of the meninges (subdural hematoma: 22%) 4 , 5 , 8 , 9 , 16 , 18 , 19) or into the subarachnoid space (subarachnoid hemorrhage: 16%) 7 , 10 , 20 , 21 , 24) ; multiple sites can also be involved (13%), such as intratumoral bleeding with subdural hematoma 2 , 23 , 29) or subarachnoid hemorrhage. 13) …”