RESUMO
We report a case of a 21-year-old white woman with a three-week history of rapidly progressive paresis and paresthesias of her extremities presenting as an intramedullary cervical cord lesion. Computer-assisted tomography and magnetic resonance imaging demonstrated a normal brain with a cervical cord enlargement suggestive of a primary spinal cord tumor. Her neurological deficits progressed despite dexamethasone; hence, laminectomy was performed with open biopsy of the cord lesion. The pathological specimens were sent to the Mayo Clinic and Kansas University for cell-type determination, due to their bizarre morphology. Both institutions concluded the biopsy specimens were demyelinated axonal plaques consistent with multiple sclerosis. This case illustrates that demyelinating disease can mimic spinal cord tumor, even with MRI scanning. Multiple sclerosis is a chronic demyelinating disease of the central nervous system. The clinical diagnosis requires documentation of lesions occurring on more than one occasion and at more than one site in the central nervous system. To improve the accuracy of the diagnosis of multiple sclerosis, spinal fluid analysis, visual and auditory evoked responses and radiologic imaging have been proposed. We report a patient with multiple sclerosis who presented with symptoms and physical findings suggesting a primary cervical cord tumor. Localized enlargement of the cervical cord was documented on magnetic resonance imaging. This is the first reported description of histopathologically confirmed spinal cord demyelination presenting as an intramedullary cervical cord tumor.
