[Intradural extramedullary tumor of lower spinal cord in a 89-year-old man with cervical spondylosis and lumbar spondylolisthesis].
A 89-year-old man was admitted because of slowly progressive gait disturbance during these several years. Neurological examination revealed paraparesis with bilateral sensory disturbance in the lower extremities, more severely on the left side. Vibration sense was almost completely disturbed under the level of bilateral crista iliaca. Deep tendon reflexes decreased in the lower extremities. No urinary incontinence was observed. The narrow spinal canal and cervical spondylosis were seen at the C 5-6 level, showing the anterior-posterior distance of 10 mm. Computed tomography of the lumbar spine showed spondylolisthesis between the level 4 and 5. CSF showed high protein concentration (300 mg/dl), whereas normal cell counts. These findings suggested the following two possibilities; cervical myelopathy associated with the disturbance of the cauda equina due to lumbar spondylolisthesis, or the disturbance at the lower thoracic or upper lumbar level of spinal cord. The spinal MRI revealed the irregular mass lesion in the lower spinal cord at the level of spine Th 11-12 on T2 weighted images, with enhancement by Gd-DTPA on T1 weighted images. These MRI findings suggested the intradural extramedullary tumor, such as benign neurinoma or meningioma. No clear cut lesions were found at the cervical spinal cord or at the cauda equina. MRI was useful for the diagnosis of sites and lesions of spinal cord in the present case, whose neurological signs and symptoms could be explained by the coexistent cervical spondylosis and lumbar spondylolisthesis.
Wada
H
H
Department of Neurology, Tokyo Metropolitan Geriatric Hospital.
Yamanouchi
H
H
Kobayashi
S
S
Toyokura
Y
Y
D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000150:complications* / Q000175:diagnosis; D009442:Neurilemmoma / Q000150:complications* / Q000175:diagnosis; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000175:diagnosis; D013128:Spinal Osteophytosis / Q000209:etiology*; D013168:Spondylolisthesis / Q000209:etiology*