[Spinal intramedullary cavernous angioma associated with hematomyelia: case report with sequential MRI follow-up and histological verification of hematoidin deposits].
A 61-year-old woman first experienced sudden lower back and right leg pain 3 years prior to surgery. At this time, MRI showed an intramedullary cavernous angioma at Th10-11 with central T2 high and peripheral T2 low signal intensity. However, she completely recovered in two weeks. Four days prior to the present admission (day of the second hemorrhage), she again experienced severe lower back and right leg pain, followed by complete paralysis of the right leg. Despite vigorous medical treatment including administration of steroid, hemostatics and glycerol, her condition became aggravated with complete paraplegia and loss of sphincter control by the 4th hospital day. MRI taken two days after the second hemorrhage showed an increase of peritumoral T2 hypointensity and another area of T2 hypointensity in the lumbar spinal cord at L1-Th12 with cord swelling. MRI 13 days after the second hemorrhage showed that these areas of T2 hypointensity had changed to T1 and T2 hyperintensity suggesting conversion of deoxyhemoglobin to methemoglobin. Subsequent MRI showed longitudinal punctuate propagation of methemoglobin from the angioma down to the lumbar enlargement and into the conus medullaris, where a 30 x 6 mm spindle-shaped area of T1 and T2 hyperintensity indicating hematomyelia had formed. Total removal of the angioma was followed by gradual recovery and decrease in the size and signal intensity of the hematomyelia. Histopathological examination demonstrated the typical features of cavernous angioma with deposition of hematoidin. Propagation of extravasated blood from the ruptured thoracic cavernoma to the conus medullaris, with splitting of spinal cord nerve fibers, was demonstrated by MRI.
Nagashima
C
C
Department of Neurosurgery, Saitama Medical School.
Masuda
T
T
Nagashima
R
R
Enomoto
K
K
Watabe
T
T
Morita
H
H
Takahama
M
M
D001663:Bilirubin / Q000378:metabolism*; D005260:Female; D006392:Hemangioma, Cavernous / Q000175:diagnosis* / Q000473:pathology; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013116:Spinal Cord / Q000378:metabolism / Q000473:pathology*; D013120:Spinal Cord Neoplasms / Q000175:diagnosis* / Q000473:pathology
D001663:Bilirubin