Spinal Intradural Schwannoma with Acute Intratumoural Haemorrhage: Case Report and Review

Abstract

Schwannomas account for around half of all intradural spinal tumours, with chronic progressive symptoms as the most common presenting features. Intratumoural haemorrhage as a presenting feature of spinal schwannoma is very rare and only 11 cases have been reported till date. Authors here report a previously asymptomatic 40-year-old male who presented with acute onset paraplegia 12 hours after a minor trauma. MR imaging revealed a C7-D3 intradural-extramedullary lesion with features of acute blood and showing no enhancement. Emergency laminectomy and complete removal of the mass was performed and histopathology revealed features of schwannoma with haemorrhage. Patient had modest improvement of his neurological deficits at a follow-up of 6 months. Pertinent literature is reviewed in brief.

Hemorrhagic Spinal Schwannoma in Thoracolumbar Area with Total Paraplegia

“…Hemorrhagic type of spinal schwannoma is a rare case and more commonly found in the cranial region of the spine [5]. The tumor in the spine is more likely found around the thoracolumbar junction region or the cervical region due to the high movement in these segments and the high density of the nerve roots [2–5]. The difference between this type of schwannoma and other types is the clinical finding of bleeding in the tumor mass intraoperatively.…”

“…The difference between this type of schwannoma and other types is the clinical finding of bleeding in the tumor mass intraoperatively. From microscopic findings, it is shown that the hemorrhagic background along with Verocay bodies, spindle-shaped Schwann cell areas (Antoni type A tissue), and loose myxoid area (Antoni type B tissue) [5–8].…”

“…Diagnosis of hemorrhagic type of spinal schwannoma is made according to clinical history, physical examination, laboratory examination, radiological examination, and histopathological examination. Patients initially presented with local pain and signs of compression of neural structures with neurological deficits developing in late phase [5, 8]. Patients feel segmental pain followed by local pain, motor weakness, gait ataxia, bladder paresis, and dysesthesia.…”

“…Spinal schwannomas are generally slow-growing, and the symptoms worsen over time. In physical examination, we can find motoric or sensory impairment (neurological deficit) [5, 8]. In laboratory examination, we can find no signs of infection and positive/negative tumor markers.…”

Acupuncture Analgesia in a Patient with a Lumbar Spinal Nerve Root Schwannoma – A Case Report

“…Schwannomas comprise nearly 50% of all intradural spinal tumors, with chronic progressive symptoms as the most common clinical presentation [1]. They are benign tumors arising from nerve roots and based on their location they can take the form of a dumbbell-shaped mass [2].…”