Paraplegia caused by intratumoral hemorrhage within thoracic epidural granuloma.
An 84-year-old man presented with a rare case of spinal epidural granuloma with intratumoral hematoma resulting in acute paraplegia. He was admitted to our hospital because of lumbago and hematemesis following a fall 10 days before. Progressive paraparesis occurred 2 days after admission. Neurological examination showed paraplegia and hypesthesia below the T10 level. Thoracic radiography revealed some spondylotic changes of the thoracic vertebrae without osteolytic changes. Sagittal T(1)- and T(2)-weighted magnetic resonance imaging of the thoracic spine demonstrated a hyperintense epidural mass lesion compressing the dorsal portion of the thoracic spinal cord at T10-11 space. Emergency laminectomy was performed, and the epidural encapsulated hematoma and elastic yellowish mass adhered to the dura mater were totally removed. Histological examination of the excised specimens showed a granuloma. Motor weakness improved after surgery, and he could walk with a cane about 3 months after surgery. The minor spinal injury probably caused intratumoral hemorrhage within a previous epidural granuloma, suddenly resulting in the paraplegic symptoms.
Fukao
Shigeharu
S
Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka. shigefk@okamato-hp.or.jp
Hanakita
Junya
J
Kitahama
Yoshihiro
Y
Ando
Naoto
N
Minami
Manabu
M
D000369:Aged, 80 and over; D019299:Decompression, Surgical; D004388:Dura Mater / Q000473:pathology / Q000601:surgery; D020802:Epidural Abscess / Q000150:complications / Q000473:pathology*; D004824:Epidural Space / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D006099:Granuloma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D046748:Hematoma, Epidural, Spinal / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D010264:Paraplegia / Q000209:etiology; D020127:Recovery of Function / Q000502:physiology; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D013122:Spinal Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome