Sudden post-traumatic sciatica caused by a thoracic spinal meningioma

Abstract

Spinal meningiomas usually present with slowly progressive symptoms of cord and root compression, while a sudden clinical onset is very rare. A 35-year-old previously symptom-free woman presented sudden right sciatica and weakness of her right leg following a fall with impact to her left foot. A neurological examination showed paresis of the right quadriceps, tibial and sural muscles, increased bilateral knee and ankle reflexes and positive Babinski sign. Magnetic resonance imaging (MRI) revealed the presence of a spinal T11 meningioma in the left postero-lateral compartment of the spinal canal; at this level, the spinal cord was displaced to the contralateral side with the conus in the normal position. At surgery, a meningioma with dural attachment of the left postero-lateral dural surface was removed. The intervention resulted in rapid remission of both pain and neurological deficits. Spinal meningiomas may exceptionally present with sudden pain and neurological deficits as result of tumour bleeding or post-traumatic injury of the already compressed nervous structures, both in normal patients and in those with conus displacement or tethered cord. In this case, the traumatic impact of the left foot was transmitted to the spine, resulting in stretching of the already compressed cord and of the contralateral lombosacral roots. This case suggests that low thoracic cord compression should be suspected in patients with post-traumatic radicular leg pain with normal lumbar spine MRI.

Management of High-Grade Meningioma: Present, Past and Promising Future

“…The first modality used to assess neurological indications or symptoms is frequently computed tomography (CT), which is also frequently the modality that finds an accidental injury [27]. For the presentation of tumourinduced osseous alterations such remodelling with localized hyperostosis and bone thickening or bone invasion with concomitant osteoblastic response (more rarely osteolysis) in malignant patients, CT continues to be the gold standard alongside MRI [28][29][30] (Figure 2).…”

“…While unenhanced phase-contrast MR venogram (and also black-blood MR imaging) has been shown to be a valid tool in detecting sinus invasion, MR venogram is often employed to evaluate venous sinuses invasion thrombosis or occlusion. For both diagnosis and follow-up, MRI of the spine is the preferred modality; the features are comparable to intracranial meningiomas [28][29][30].…”