title: Surgical treatment for posttraumatic hemorrhage inside a filum terminale myxopapillary ependymoma: a case report and literature review.
abstract: Symptoms of cauda equina syndrome due to ependymoma in the conus medullaris or filum terminale develop slowly. However, hemorrhagic change inside spinal tumors can induce acute neurologic decline. Here, we report a case of posttraumatic hemorrhage inside a filum terminale myxopapillary ependymoma presenting as acute neurologic decline, which had a positive prognosis after surgical resection.
  
  
  
  A 28-year-old man presented with buttock pain, sensory disturbance, and motor weakness of bilateral lower extremities after falling on ice during smelt fishing. Magnetic resonance imaging demonstrated a mixed-intensity hemorrhagic intradural mass extending from L1 to L2.
  
  
  
  The patient underwent emergent surgical decompression and resection. Pathologic examination revealed a myxopapillary ependymoma with intratumoral hemorrhage. After surgery, the patient demonstrated gradual improvement in neurologic deficits and no tumor recurrence.
  
  
  
  This is the first case of a filum terminale myxopapillary ependymoma with an acute neurologic decline after injury. Early diagnosis and treatment are associated with favorable outcomes.
authors.affiliation: Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan. dai_sampo@yahoo.co.jp.|Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. dai_sampo@yahoo.co.jp.
authors.forename: Daijiro
authors.initials: D
authors.lastname: Morimoto
authors.affiliation: Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan.
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Isu
authors.affiliation: Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital, Chiba, Japan.
authors.forename: Kyongsong
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Isobe
authors.affiliation: Department of Pathology, Kushiro Rosai Hospital, Hokkaido, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Pathology, Kushiro Rosai Hospital, Hokkaido, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Department of Diagnostic Pathology, Asahikawa Medical University, Hokkaido, Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Takei
authors.affiliation: Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Morita
mesh_terms: D000058:Accidental Falls; D000328:Adult; D002420:Cauda Equina / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D004806:Ependymoma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011128:Polyradiculopathy / Q000209:etiology* / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery
keywords: Cauda equina; Ependymoma; Hemorrhage; Injury