Spontaneous hemorrhage of a spinal ependymoma: a rare cause of acute cauda equina syndrome: a case report.
METHODS
An interesting case of spontaneous bleeding from an ependymoma of the filum terminale is presented.


OBJECTIVE
To document a rare case of rapid neurologic deterioration as a consequence of spinal tumoral hemorrhage and to highlight important issues regarding tumor histologic subtype and the impact of anticoagulation that have emerged from an illuminating review of the literature.


BACKGROUND
To our knowledge, there have been only 8 reported cases of hemorrhage from an ependymoma of the filum terminale or conus medullaris causing acute cauda equina syndrome. Bleeding is described in the pathology texts as being a consequence of the vascular architecture of the myxopapillary subtype and so postulated to be more common in this group. Anticoagulation is recognized to increase the frequency of tumoral bleeding, but no studies report its effect of severity of clinical presentation.


METHODS
We report the case of a 57-year-old woman who developed nontraumatic acute cauda equina syndrome, including sphincter compromise. She underwent a lumbosacral laminectomy for evacuation of a hematoma, at which stage a filum terminale ependymoma was excised. Histopathologic analysis demonstrated it to be of a nonmyxopapillary subtype.


RESULTS
The patient demonstrated gradual improvement of the neurologic deficit. At 12-month follow-up, her saddle area sensory deficit has resolved, her right lower limb is much stronger allowing her to walk long distances, and she is successfully performing intermittent self-catheterization of her bladder.


CONCLUSIONS
The possibility of an underlying tumor should always be borne in mind so that adequate preoperative planning can be undertaken. The presence of the myxopapillary subtype should not prevent a clinician from excluding other reasons for hemorrhage, and counseling when reinstituting anticoagulation must include warning against a worse prognosis from any future hemorrhage.
Tait
Matthew J
MJ
Department of Neurosurgery, Essex Centre for Neurological Sciences, Oldchurch Hospital, London, UK.
Chelvarajah
Ramesh
R
Garvan
Neil
N
Bavetta
Seb
S
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications; D002420:Cauda Equina / Q000098:blood supply; D004806:Ependymoma / Q000098:blood supply / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006406:Hematoma / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications; D011128:Polyradiculopathy / Q000209:etiology*; D012214:Rheumatic Heart Disease / Q000150:complications; D012422:Rupture, Spontaneous; D013125:Spinal Neoplasms / Q000098:blood supply / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D019851:Thrombophilia / Q000188:drug therapy / Q000209:etiology; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin