Hydrocephalus as presenting feature of spinal astrocytoma in a adolescent patient

Abstract

We report the case of an adolescent with a thoracic spine astrocytoma whose initial presentation was communicating hydrocephalus. We speculate that the mechanism may be reduced meningeal compliance due to meningeal spread of the tumour. Craniospinal MR imaging should be considered as part of the routine work up for patients presenting with unexplained hydrocephalus, elevated CSF protein and/or long tract symptoms/signs.

Intramedullary Thoracic Spine Astrocytoma Presenting as Hydrocephalus in an Infant: A Case Report

“…However, we acknowledge the limitation of this hypothesis as CSF is absorbed in other fashions, not just at the level of the arachnoid granulations, such as from the basal cisterns via the nerve sheaths into the lymphatics. Two cases have illustrated patients with spinal astrocytomas of the lower thoracic region with diffuse leptomeningeal enhancement, both of whom developed hydrocephalus [7,8] . The literature emphasizes 2 additional theories to explain a cause of increased intracranial pressures.…”

“…One suggests that the elevated protein count alters the viscosity of the CSF such that it impairs natural absorption. In cases of leptomeningeal spread, there may be an additional compromise of the mechanical properties of the subarachnoid layer which disrupts natural absorption [7,8,[11][12][13][14] .…”

“…Development of hydrocephalus in instances of pediatric spinal cord tumors, while rare, has been reported in the literature [1,[6][7][8] . In this report, we discuss an upper thoracic intramedullary spinal cord tumor that uniquely presented as acute symptomatic communicating hydrocephalus.…”