Cervicomedullary Cavernous Hemangioma presenting as Spinal Shock Syndrome and Dysfunction: A case report and review of related literature

ABSTRACT

INTRODUCTION@#Cavernomas in the brainstem and spinal cord are rare than their intracranial counterparts, and occurrences specifically at the cervicomedullary junction are infrequent. In this report, we present a case of a cervicomedullary cavernoma which manifested with spinal shock and dysfunction.@*CASE REPORT@#We describe a patient who exhibited spinal shock syndrome and a stepwise decline in spinal cord function. A 33-year-old woman initially complained of right upper arm and occipital referred pain from the atlantoaxial region. Three days later, she experienced bowel and urinary incontinence. Subsequently, quadriparesis and numbness affecting all limbs developed after one week, followed by life-threatening respiratory depression after nine days. Magnetic resonance imaging revealed a lesion in the cervicomedullary junction, identified as a cavernous hemangioma. During the hospital stay, fragmented reflex activity gradually returned. Upon follow-up, the bowel and urinary incontinence, motor impairments, and sensory impairments showed improvement.@*CONCLUSION@#The proposed mechanism for the mass effect of this cavernous malformation on the spinal cord at the cervicomedullary junction was likely due to pressure effects caused by shifting dynamics. Understanding the natural history of cavernous malformations, regional neurovascular anatomy, safe entrance points to the brainstem, routes to the craniovertebral junction from the base of the skull, and specific microsurgical procedures for their removal are necessary for appropriate treatment. However, these considerations should be balanced against knowledge of the associated hazards and treatment recommendations.