Symptomatic Expansile Vertebral Hemangioma Causing Conus Medullaris Compression

Donahue, Thomas C.; Mick, Timothy J.

doi:10.1016/j.jmpt.2005.02.017

Cited by 13 publications

(6 citation statements)

References 23 publications

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“…Most trabeculae are atrophic due to the abnormal blood vessels although some become thickened and sclerotic. Cavernous hemangiomas have multiple large thin walled vascular spaces while capillary hemangiomas have multiple capillary channels separated by reactive fibrous tissue [4]. Work-up for aggressive hemangiomas may include angiography to determine vascularity, identify feeding and draining vessels and identify the blood supply to the cord.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Compression by Thoracic Vertebral Hemangioma—A Case Report

Kalina¹

2012

OJMI

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A 68 year old with lower extremity numbness, vibratory sensation loss, coldness and burning of his feet, unsteady gait, frequent falls and a sensory level had an MRI demonstrating a T7 and T8 vertebral body/posterior element lesion with epidural extension, cord compression and foraminal extension (Figures 1-5). Decompressive laminectomy/resection confirmed vertebral hemangioma, a common benign neoplasm that typically remains asymptomatic, found incidentally in 10% of the population. Progressive vertebral body hemangiomas may cause cord or nerve root compression due to epidural tumor extension, expanded bone, hematoma or fracture. Radiographs demonstrate course vertical striations caused by thick trabeculae. CT in indolent lesions demonstrates fat density while compressive lesions demonstrate soft tissue density. Indolent lesions follow fat signal on MRI; symptomatic lesions are T1 isointense/T2 hyperintense. Work-up for aggressive hemangiomas includes angiography to determine vascularity, identify feeding/draining vessels and identify blood supply to the cord. Biopsy helps differentiate hemangioma, lymphoma, myeloma or metastasis. Management of symptomatic hemangiomas includes vertebroplasty for pain, radiation for pain, compression or pre-op and decompressive laminectomy for epidural disease. Embolization of feeding vessels may be performed pre-op or may be curative. Hemangioma causing cord compression and neurologic symptoms by extraosseous extension is much less common than benign hemangioma. Imaging features may suggest potential for progression.

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Compression by Thoracic Vertebral Hemangioma—A Case Report

Kalina¹

2012

OJMI

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“…Vertebral hemangiomas that cause neurological deficits are rarely located in the lumbar vertebrae. 2,8,17,31 Lesions in this region can cause cauda equina syndrome 2 and compression of the medullary conus. 31 The current case demonstrates the consequences of nerve root compression and establishes that lumbar vertebral hemangiomas can mimic the signs and symptoms of herniated discs.…”

Section: Discussionmentioning

confidence: 99%

“…2,8,17,31 Lesions in this region can cause cauda equina syndrome 2 and compression of the medullary conus. 31 The current case demonstrates the consequences of nerve root compression and establishes that lumbar vertebral hemangiomas can mimic the signs and symptoms of herniated discs. The patient's hip flexor and quadriceps weakness, along with the diminished patellar reflex, are consistent with the L-3 and L-4 nerve root compression seen on MR imaging.…”

Section: Discussionmentioning

confidence: 99%

Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms

Chen

Heuer²,

Zaghloul³

et al. 2007

SPI

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✓Vertebral hemangiomas are common entities that rarely present with neurological deficits. The authors report the unusual case of a large L-3 vertebral hemangioma with epidural extension in a 27-year-old woman who presented with hip flexor and quadriceps weakness, foot drop, and leg pain. The characteristics of the mass on magnetic resonance imaging suggested an aggressive, hypervascular lesion. The patient underwent embolization of the lesion followed by direct intralesional injection of ethanol. Significant resolution of clinical symptoms was observed immediately after the procedure and at her follow-up visits. Follow-up imaging studies obtained 9 months after the procedure also documented a considerable reduction in the size of the hemangioma with minimal loss of vertebral height and a mild kyphosis at the affected level. On repeated imaging studies obtained 21 months postoperatively, the size of the hemangioma and the degree of vertebral body compression were stable. As demonstrated in this case, patients with vertebral hemangiomas can present with acute nerve root compression and signs and symptoms similar to those of disc herniation. Vertebral hemangiomas can be treated effectively with interventional techniques such as embolization and ethanol injection.

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“…Die NHG-Richtlinie nennt als Red flags für das lumbosakral radiokuläre Syndrom: Radikulär ausstrahlende Schmerzen in einem Bein, Schmerzen in einem Bein sind schwerwiegender als die Schmerzen im Lendenbereich und neurologische Kribbel-und Ausfallerscheinungen [3]. Mehrere Publikationen geben eine Qualifikation für das Entstehen von neurologischen Zeichen in Kombination mit Rückenschmer-zen: neuer [40], akuter [19], progressiver [1,5,29,31,40] und (stufenweise, aber unvermeidbarer) heimtückischer Beginn [9]. Roberts beschreibt das Ergebnis eines Surveys unter Hausärz-ten und nennt Reflexaktivität der plantaren Muskulatur als Red flag für ernsthafte Wirbelsäulenerkrankungen [32].…”

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“…Die NHG-Richtlinie gibt an, dass nächtliche Schmerzen unter anderem in Kombination mit kontinuierlichem Schmerz unabhängig von Haltung und Bewegung ein Alarmsignal für Malignität sind [3]. CSAG [4] und CBO [22] [1, 3 -5, 9, 18, 22, 36, 37, 40] 3 Malignität in der Krankengeschichte Krebs/maligne Erkrankungen in der Krankengeschichte [1, 3 -5, 9, 10, 12, 14, 18, 20, 22, 28, 31, 35 -37, 40] 4 konstitutionelle und konditionelle Symptome Fieber; Schüttelfrost; regelmäßiges Unwohlsein/Übelkeit; Müdigkeit; Nachtschwitzen; ungeklärter Gewichtsverlust [1, 3 -5, 9, 10, 12, 14, 18, 20, 22, 28, 31, 35 -37, 40] [1, 2, 4, 5, 9, 11, 14, 18, 19, 22, 29 -32, 34, 36, 37, 40] 7 nächtliche Schmerzen Schmerz, der sich in Rückenlage verschlimmert [1,18,20,26,40] ernsthafte Schmerzen während der Nacht [1,14] konstanter nächtlicher Schmerz [3,9,32] ernsthafte unerträgliche nächtliche Schmerzen [18,31] konstante progressive (nicht mechanische/von Haltung und Bewegung unabhängige) Schmerzen, die sich bei Bettruhe nicht verringern [3,4,9,22,36,37] Schmerzen, die nachts schlimmer sind; intensivste Schmerzen, die sich durch NSAID nicht verbessern [29,40] hartnäckige Schmerzen [39] Ruheschmerz [31,39] morgendliches Erwachen, ohne dass sich der Schmerz verringert [31] Schmerzen, die spontan nachts entstehen und nicht abnehmen [5,35] [15,24] langanhaltende/regelmäßige Kortisoneinnahme, an ein hohes Risiko für Osteoporose gebunden <...>…”

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