Acute spinal cord compression from an extraosseous vertebral hemangioma with hemorrhagic components: a case report.

OBJECTIVE: This case report presents a patient with acute compression myelopathy caused by acute hemorrhage of a thoracic vertebral hemangioma extending into the epidural space. CLINICAL FEATURES: A 22-year-old male patient experiencing back pain for 5 months presented to our medical facility complaining of sudden onset numbness and muscle weakness in the lower extremities. INTERVENTION AND OUTCOME: Magnetic resonance imaging of the thoracic spine revealed a T5-level mass involving predominantly the posterior vertebral elements, extending into the epidural area, and showing significant gadolinium enhancement. Hemorrhagic signal changes were noted within the epidural component of the mass. In addition, the epidural mass component was noted to significantly compress the spinal cord. The patient was referred for emergency surgery with the preliminary diagnosis of epidural vertebral hemangioma with hemorrhagic component; a decompression laminectomy was performed without preoperative angiography. The patient's complaints improved completely after surgery, and radiotherapy was instituted for the residual tumor tissue. CONCLUSION: The presence of acute or subacute myelopathic symptoms is usually suggestive for malignancy or metastasis. However, in young patients, vertebral hemangioma, causing acute hemorrhage, should be considered in the differential diagnosis. Decompression surgery should be done in such cases before neurological symptoms become irreversible.

[Acute paraplegia caused by hypertensive spinal epidural haematoma]. / Hipertansif spinal epidural hematomun neden oldugu akut parapleji.

The hypertension is an uncommon cause in acute spinal epidural haematomas. The severe motor disability and need to emergency treatment to avoid the permanent neurological impairments underline its importance. Seventy-five year old male, admitted with acute paraplegia, numbness in the lower extremities and urinary incontinence for 4 hours. The neurological examination showed complete paraplegia, numbness from the below of thoracal 9 dermatomes, and loss of all sensory motor reflexes including anal reflexes. The blood pressure was 210/120 mm Hg on his admission. Thoracolomber magnetic resonance examinations detected an acute epidural haematoma, which was compressing to the cord. The patient underwent emergent laminectomy involving T 9 to L 2 and clots were removed with microsurgical technique. The patient was mobilized on the 3. and discharged from the hospital on the 7. postoperative day without neurological impairment. Although majority of the spontaneous spinal epidural haematomas is a recognized idiopathic condition, hypertension is much more commonly seen etiological factor than estimated. Early diagnosis, surgical decompression of the spinal cord and high dose corticosteroids might result in complete recovery.

[Posttraumatic tension pneumocephalus causing herniation]. / Herniasyona neden olan posttravmatik tansiyon pnömosefalus.

A 12 year old boy was admitted to emergency service with loss of consciousness, convulsions and anisocoria of the right eye along the history of upper respiratory tract infection for the last four days. Two months ago he was hospitalized at the intensive care unite due to motorcycle accident with frontal fracture and minimal frontal pneumocephalus. He was treated for ten days and discharged without any neurological impairment. The last computerized tomography showed right frontal air of 5x5x7 cm. multiple airs in the ventricular system and in the upper central canal of the cervical region. The air was removed immediately through a right frontal burr-hole with a bedside procedure. The patient's neurological status rapidly improved and ten days after computerized tomography showed clearly resolution of the air. The presented case is an interesting example of post traumatic pneumocephalus due to herniation and widespread intracranial air. The situation can be explained with acute penetration of huge amount of air into the cranium through the frontobasal fracture and torn dura by strong Valsalva 's maneuver resulting from coughing and sneezing in the course of upper respiratory tract infection. We suggest close follow up, frequent control computerized tomography scans, preventive and effective treatment respiratory tract infections along 3-6 months in similar cases.