[Anaplastic oligoastrocytoma of the spinal cord: diagnostic difficulties. Case report].
The authors report a rare case of 49-years old woman with rapidly progressing anaplastic oligoastrocytoma primarily localized in the spinal cord. Increasing spastic paresis of the right lower limb was concomitant with decrease in superficial sensibility in this limb and the right side of the trunk below Th10 level, suggested a lesion within the spinal cord. However, it was the difficult confirming the diagnosis by spinal MR imaging, and the negative result of the first MR examination (performed 5 weeks after manifestation of first clinical symptoms of the disease) delayed surgical treatment. During the next 3 weeks the neurological syndrome increased to spastic paraparesis with sphincters dysfunction and decrease in superficial and vibratory sensibility within the lower limbs and the trunk below the Th10 level. The second MR examination of the spine revealed an intraspinal tumour at Th8-Th10 levels. Surgical (partial excision of the tumour) and radiation treatment was given. Histopathological examination of tumour tissue showed the presence of anaplastic oligoastrocytoma. During the follow-up of our patient we found cerebral foci, probably of metastatic origin ascending with cerebrospinal fluid. More than 5 months after the diagnosis was established the patient died of primary disease. The imaging parameters of both spinal MR examinations were similar, however, on second examination narrower field of vision was used. In both cases Magnevist was administered. Discussing factors which might be responsible for the false-negative result of spinal MR examination--the examination of choice for detection of proliferative transformation--the authors take artefacts connected with respiratory and circulatory function, peristaltic movements, and with field of vision into consideration.
Kliniki Neurologii i Epileptologii CMKP w Warszawie.
M
M
Michałowska
J
J
Jedrzejczak
L
L
Królicki
H
H
Kroh
W
W
Koszewski
D016477:Artifacts; D001254:Astrocytoma / Q000150:complications / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D001932:Brain Neoplasms / Q000556:secondary; D003287:Contrast Media; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D018714:Radiotherapy, Adjuvant; D013120:Spinal Cord Neoplasms / Q000175:diagnosis*; D013904:Thoracic Vertebrae
D003287:Contrast Media; D019786:Gadolinium DTPA