Intradural calcifying pseudoneoplasm of the neuraxis presenting as a cauda equina syndrome

Abstract

Background:Calcifying nonneoplastic pseudoneoplasms of the neuraxis (CAPNON) have been reported in 59 cases in literature, however, they rarely involve the spinal cord. Owing to the advances in immunohistochemical markers, their structure and origin are better understood now.Case Report:We present the case of a 72-year-old female who had longstanding history of low back pain that exacerbated 20 days prior to the presentation to the emergency room with a frank cauda equina syndrome. The lumbar computed tomography scan showed a hyperdense lesion, suggestive of calcified tumor, whereas the magnetic resonance imaging revealed a hypointense lesion on theT1 and T2-weighted images, without contrast enhancement or edema on fluid-attenuated inversion recovery. She underwent an emergent L2-L4 laminectomy and L3-L4 discectomy with resection of L2 intradural tumor, following which she regained normal function.Conclusion:A 72-year-old female presented with a cauda equina syndrome attributed to an L2 intradural CAPNON. Following gross total resection, the patient was neurologically intact.

New insights into calcifying pseudoneoplasm of the neuraxis (CAPNON): a 20‐year radiological–pathological study of 37 cases

“…In the neck (facial bones, skull base, craniovertebral junction), reported locations include the orbits, sella, clivus, temporal bone, cranial nerves, skull base foramina, and craniocervical junction 24‐28 . In the spine, lesions have been reported at the cervical, thoracic, lumbar and sacral levels, with variable involvement of the spinal cord, facet joints, intervertebral disc, dura, and neural foramina 2,7‐11,29‐33 . CAPNON has also been reported in association with several inflammatory, degenerative, and vascular pathologies, and, benign and malignant neoplastic pathologies.…”

Calcified Pseudoneoplasm of the Neuraxis

“…Headaches, epileptic seizures, cranial nerve dysfunction, and neck/back pain have all been reported; some CAPNONs are discovered incidentally. [11][12][13] The diagnosis of a CAPNON can be strongly suggested by its imaging appearance, especially when intracranial. True to their name, CAPNONs are highly calcific, a feature that is readily apparent on CT.…”

Surgically treated intracranial supratentorial calcifying pseudoneoplasms of the neuraxis (CAPNON) with drug-resistant left temporal lobe epilepsy: A case report and review of the literature

“…In the literature, there were 54 (60%) intracranial cases [3], [6], [7], [10], [16], [20], [24], [25], [26], [27], [28], [29], [31], [32], [33], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [50], [51], [52], [53], [55], [56], [57], [58], [59] and 36 spinal cases (40.0%) [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23] of CAPNON. Of the intracranial cases, 36 lesions were supratentorial [3], [6], [7], [10], [16], [20], [24], [25], [28], [29], [31], [32], [33], [35], [38], [40], [41], [42], [43], [44], [47], [50], [51], [52], [55]...…”

“…Calcifying pseudoneoplasms of the neuraxis (CAPNONs) are very rare lesions; only 90 cases including 54 (60%) intracranial cases and 36 (40%) spinal cases have been reported [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] . These lesions are benign and slow growing, and can present anywhere in the central nervous system, both intracranially and involving the spine.…”