Isolated, primary extranodal Hodgkin's disease of the spine: case report.

OBJECTIVE AND IMPORTANCE: To describe an unusual case of isolated, primary spinal Hodgkin's disease to draw attention to this disease as a possible diagnosis in patients with mixed inflammatory cell infiltrate lesions located in the spine. CLINICAL PRESENTATION: A 54-year-old African American woman presented with back pain and progressive lower-extremity weakness as a result of spinal cord compression from Hodgkin's disease of the thoracic vertebrae. INTERVENTION: The patient underwent decompressive surgery with stabilization, then was incorrectly treated with antituberculosis medication. When the disease progressed, later investigations revealed Hodgkin's disease, which responded to a course of radiation therapy. An extensive examination failed to detect lymphoma elsewhere. CONCLUSION: Isolated, primary extranodal Hodgkin's disease of the spine is extremely rare. Seven other cases were reported in 1954. Although the Hodgkin's disease in these cases may arise in the bone of the spine, the possibility of origin in the paraspinous soft tissues also cannot be excluded.

Multicentric intracranial smooth-muscle tumor in a woman with human immunodeficiency virus. Case report.

A 31-year-old woman with acquired immunodeficiency syndrome (AIDS) was found to harbor both a pulmonary smooth-muscle tumor and an intracranial extraaxial smooth-muscle tumor of the parasellar region. The frequency of smooth-muscle tumors (leiomyoma and leiomyosarcoma) has increased with AIDS, but much more so in children than in adults. Only nine cases of human immunodeficiency virus-related smooth-muscle tumors have been previously reported in adults, and only one of these was located intracranially.

Thoracic epidural lipomatosis with associated syrinx: case report.

A 54-year-old black male with a 15-year history progressive lower extremity weakness was evaluated with a thoracic MRI that revealed epidural lipomatosis extending from T1-T10 with an associated syrinx at T1-3. He was neither overweight nor taking steroids. A multilevel thoracic laminectomy with resection of lipoma was performed without directly addressing the syrinx. Postoperatively, his symptoms improved and an MRI obtained 1 year after surgery demonstrated resolution of the syrinx. This is the only case of epidural lipomatosis with an associated syrinx that we have seen reported in the world literature.

Combined laminectomy and thoracoscopic resection of a dumbbell neurofibroma: technical case report.

OBJECTIVE AND IMPORTANCE: We describe combined laminectomy and thoracoscopic surgery for removal of a dumbbell thoracic spinal tumor to demonstrate the feasibility of such an approach. CLINICAL PRESENTATION: We present the case of a 29-year-old man who developed chest pain and spinal cord compression from a thoracic dumbbell neurofibroma. TECHNIQUE: Surgical approaches for benign nerve sheath tumors that extend from the spinal cord into the thoracic cavity include combined laminectomy and thoracotomy either in one or two stages, or a lateral extracavitary approach involving laminectomy, facetectomy, and rib resection in a single stage. We performed a combination laminectomy and thoracoscopic tumor resection in a single stage with good results. CONCLUSION: This technique has not been reported previously in the literature. It has the advantage of avoiding the potential morbidity of a thoracotomy, as well as the extensive muscle dissection and pain associated with the lateral extracavitary approach.

Posterior decompression of the vertebral artery narrowed by cervical osteophyte: case report.

BACKGROUND: Symptomatic vertebral artery compression caused by cervical spondylosis usually is caused by compression of the artery by osteophytes arising from the uncinate process. Compression from facet joint osteophytes is seldom reported. CASE DESCRIPTION: A 69-year-old male developed symptomatic vertebral artery stenosis secondary to an osteophyte arising from the superior facet of the sixth cervical vertebra posterior to the artery. A posterior decompression of the vertebral artery with removal of the offending facet joint complex relieved the patient's transient neurologic events. CONCLUSION: Symptomatic vertebral artery stenosis may be caused by osteophytes compressing the vertebral artery anteriorly from the uncinate process or posteriorly from the facet complex.

C2/3 instability in a child with Down's syndrome . case report and discussion.

Down's syndrome patients are prone to cervical ligamentous laxity, the vast majority of which is at the C1/2 level. We describe the case of a 2-year-old girl with Down's syndrome who was found to have cervical instability at the C2/3 level on screening cervical spine radiographs with 9 mm of anterolisthesis of C2 on C3. She was without clinically evident neurological deficit from this condition; however, T2-weighted magnetic resonance imaging of her cervical spine revealed high intensity signal changes within the spinal cord at and above that level. She underwent posterior fusion that was complicated by poor tolerance of her Minerva-type cervical brace. She eventually developed a stable fusion with 5 mm of anterolisthesis at the C2/3 level. This is the only Down's syndrome patient with instability at the C2/3 level that we have found reported. Our experience suggests that Down's syndrome patients can have instability at C2/3 that can be successfully treated with posterior fusion.

Intramedullary tuberculoma of the spinal cord: case report.

A case report of intramedullary tuberculoma is presented. Only one other case of intramedullary tuberculoma has been reported in the North American literature in the last 30 years. It is also unique because it is the only documented case of the paradoxical enlargement of an intramedullary tuberculoma after the initiation of antituberculous chemotherapy. Excellent results were obtained with a combination of medical and surgical management.