Atypical presentations of conus medullaris and filum terminale myxopapillary ependymomas.

Out of 27 cases of spinal ependymomas seen during a 21 year period (1978-1999), we observed three out of 12 myxopapillary tumours of the conus medullaris and filum terminale with atypical presentations. All the three cases presented with subarachnoid haemorrhage and intracranial hypertension. In addition, the second patient developed persistently low CSF sugar, while the third patient developed hydrocephalus, acute autonomic crisis and SIADH. Although subarachnoid haemorrhage (SAH), intracranial hypertension and hydrocephalus were previously scarcely reported in the literature, the low CSF sugar, acute autonomic crisis and SIADH were never reported singly or in combination. Up to our best knowledge, this is the first report that clearly outlines all these atypical manifestations in this particularly interesting neoplasm. Hence, the above challenging clinical presentations should be borne in mind with cryptic presentations of lower spinal cord and filum terminale ependymomas. A proposal of the mechanism of their production is suggested.