Spinal subarachnoid hemorrhage during myelography. Case report

Traumatic spinal subarachnoid hematoma: report of a case with MRI

BACKGROUND

Spinal subarachnoid hematoma (SAH) is uncommon following traumatic injury to the spine. There are few case reports of neurologic deficit secondary to traumatic spinal SAH.

CASE DESCRIPTION

This 6-year-old boy was injured in a vehicular accident from which he became paraplegic and presented to us 1 week later. Plain X rays were normal and a myelo-computed tomography (CT) scan demonstrated an irregular intradural lesion from D10-L2. The magnetic resonance imaging (MRI) revealed an SAH at D11-12 level, posterior to the cord, which was surgically evacuated. The patient did not improve neurologically.

CONCLUSION

Significant cord injury and neurologic deficit can occur without obvious abnormalities on plain X rays or CT scan. MRI is very useful in detecting these lesions and can help in their management.

Combined neurilemmoma and angioma. Tumor of ectomesenchyme and a source of bleeding

Eight cases are described of intracranial and peripheral neoplasms composed of mixed neurilemmoma and hemangioma. It is proposed that ectomesenchyme can differentiate into neurilemmoma and angioma. The latter may be related to recently described angiogenetic factors, or to developmental factors as in rare cases of arterial angiomas. The angiomatous part may be common, but has often been overlooked. The presence of abnormal vessels, whether in kind or in number, helps explain various biological features of neurilemmoma. These vessels frequently bleed within the tumor, which results in the characteristic hemosiderin-laden macrophages. Bleeding may also occur into the cerebrospinal fluid (CSF) to create xanthochromia. The frequent increase in CSF protein in cases of neurilemmoma is attributed to transudation of serum from abnormal vessels. Less commonly, bleeding may be sufficient to cause subarachnoid hemorrhage. The dense collagen usually associated with these angiomas accounts for the relative infrequence of major hemorrhages.