Posttraumatic intratumoural haemorrhage: an unusual presentation of spinal ependymoma

Abstract

Ependymomas presenting with intratumoural and/or subarachnoid haemorrhages are seen rarely. These haemorrhages are mostly due to anticoagulation, epidural analgesia or pregnancy. A 62-year-old male farmer with cauda equina syndrome after a work-related trauma is presented. He was admitted to our hospital with paraparesis, faecal incontinance and sensory loss below the level of the lumbar-2 dermatome. Magnetic resonance imaging of the spine displayed an intradural mass lesion at the level of the first lumbar vertebrae. The lesion was excised totally via dorsal midline approach. Histopathologic examination revealed grade-3 ependymoma with intratumoural haemorrhage. The patient's symptoms were relieved completely on postoperative day 7. The patient was given information about periodical examination for recurrence and discharged on the third postoperative week. Asymptomatic spinal lesions should be considered for operation whenever detected because of unpredicted complications.

Ependimomas del filum terminal. Análisis de 20 casos consecutivos

“…Otros síntomas habituales son parestesias en miembros inferiores y alteraciones esfinterianas 20 . En la literatura existen numerosas referencias en relación con distintas formas de presentación en los ependimomas de esta localización: como hemorragias intratumorales espontáneas o traumáticas 2,25 , hemorragia subaracnoidea 35, el desarrollo de una hidrocefalia comunicante 42 , probablemente en relación con microsangrados asintomáticos o al incremento de las proteínas en el líquido cefalorraquídeo, como ya ha sido publicado en otros tumores medulares. La duración de la sintomatología previa al diagnóstico se ha reducido progresivamente desde la introducción de la RM en el diagnostico de la patología raquimedular.…”

Intraspinalependymomas and Their Association with Metastasis/ Disseminations in Patients Over a Period of 22 Years

“…There are numerous references in the literature regarding various atypical forms of presentation in ependymomas, [11,14]. One of our patients was diagnosed with a pseudovascular form, which clinically presented an acute myelopathic syndrome due to tumor bleeding, as evidenced by MRI.…”

“…From the histopathological point of view, we found that the myxopapillary group at the level of the terminal phylum was the most frequent. On the other hand, the less frequent histological subtype was the anaplastic with dorsal localization [14][15][16][17][18]. The most important and effective treatment of intraspinal ependymomas is surgery.…”

“…On the other hand, it is necessary to consider that tumor recurrences are more frequent in the cases of secondary or metastatic ependymomas than in the primary ones of the rachis and these can be associated with other neoplasms outside the CNS. It is important in the study of intraspinalependymomas to evaluate the neuroaxis to rule out the presence of disseminations / metastases in other levels [14].…”

Ependimomas del filum terminal: Análisis de 20 casos consecutivos

“…Otros síntomas habituales son parestesias en miembros inferiores y alteraciones esfinterianas 20 . En la literatura existen numerosas referencias en relación con distintas formas de presentación en los ependimomas de esta localización: como hemorragias intratumorales espontáneas o traumáticas 2,25 , hemorragia subaracnoidea 35, el desarrollo de una hidrocefalia comunicante 42 , probablemente en relación con microsangrados asintomáticos o al incremento de las proteínas en el líquido cefalorraquídeo, como ya ha sido publicado en otros tumores medulares.…”