Daijiro Morimoto1,2, Toyohiko Isu3, Kyongsong Kim4, Masanori Isobe3, Tatsuro Takahashi5, Yusuke Ishida5, Hidehiro Takei6, Akio Morita7. 1. Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan. dai_sampo@yahoo.co.jp. 2. Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. dai_sampo@yahoo.co.jp. 3. Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan. 4. Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital, Chiba, Japan. 5. Department of Pathology, Kushiro Rosai Hospital, Hokkaido, Japan. 6. Department of Diagnostic Pathology, Asahikawa Medical University, Hokkaido, Japan. 7. Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.