Hemorrhagic thoracic schwannoma presenting with intradural hematoma and acute paraplegia after spinal manipulation therapy

Abstract

Hemorrhagic conversion of spinal schwannomas represents a rare occurrence; also rare is the development of a spinal intradural hematoma after spinal manipulation therapy. We report a unique presentation of paraplegia in a patient who underwent spinal manipulation therapy and was found to have a hemorrhagic thoracic schwannoma at time of surgery in the setting of anti-platelet therapy use. In patients with spinal schwannomas, tumor hemorrhage is a rare occasion, which can be considered in the setting of additive effects of spinal manipulation therapy and antiplatelet therapy.keywords: thoracic schwannoma, hemorrhagic schwannoma, spinal schwannoma, intradural spinal hemorrhage volume 10 article 42

Acute paraplegia due to thoracolumbar schwannoma following trauma: A case report and literature review

“…Spinal injury after a traumatic event at the level of the tumor could possibly lead to bleeding, resulting in acute canal stenosis and nerve compression (19). In the present case hemorrhage within the tumor or the spinal canal, although suspected and looked for, was not identified.…”

“…Table I summarizes the reported cases of spinal schwannomas with intratumoral hemorrhage (traumatic or spontaneous), presented with acute neurologic deficit (3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). There is a limited number of cases with rapidly progressive neurological deficits due to acute cord compression, caused by tumor bleeding.…”

“…Sudden cord compression caused by tumor bleeding is similar to spinal shock (20). Nine traumatic cases with intratumoral bleeding have been reported so far (8,13,16,(19)(20)(21)(22)(23)(24).…”

A rare chronic presentation of schwannoma with hemorrhage

“…The incidence of spinal schwannomas with intratumoral hemorrhage is even rarer with only 12 cases reported within literature to the best of our knowledge [Table 1]. [2310]…”

“…[12] They are the most common intradural extramedullary (IDEM) tumors and account for 30% of all intradural tumors. [23] They often occur between the ages of 25–50 and are most commonly located in cervical and lumbar regions because of higher density of nerve roots in that region. [45] Symptoms depend on the location of the tumor and patients usually present with pain, weakness paresthesias, and numbness.…”