Nonogaki Y, Ishii M, Oda N, Nagashima C
Department of Neurosurgery, Hirosaki University School of Medicine.
No Shinkei Geka. 1992 Dec;20(12):1277-81.
A case of a 43-year-old man with coexistence of intracranial and spinal cavernous angiomas is presented. The patient had a 2-year history of severe back pain incurred by neck flexion, and he became aware of weakness of the right lower extremity and paresthesia of the left lower extremity. Neurological examinations at the time of the first admission demonstrated incomplete Brown-Séquard syndrome. Myelograph, myelo-CT and contrast enhanced CT showed an intramedullary mass at the Th3-Th5 level. The patient received laminectomy with total removal of the lesion. Pathological diagnosis was cavernous angioma. Six years later, the patient complained of subacute weakness and numbness of the left upper extremity. Head CT demonstrated a high density lesion of about 2cm in diameter in the right frontal lobe. MRI showed a mixed signal intensity lesion with a marked low-intensity rim in the same area. Total extirpation of the lesion was performed. Pathological diagnosis of the intracerebral lesion was also cavernous angioma. Intramedullary cavernous angioma is very rare. Furthermore, bifocal cavernous angiomas involving both the spinal cord and the brain are extremely rare, and, only 5 cases have been reported in the literature. To our knowledge, this is the first case diagnosed by surgical specimens of coexisting intramedullary and intracerebral lesions.
本文报告一例43岁男性患者,颅内和脊髓海绵状血管瘤并存。患者有2年因颈部屈曲引发严重背痛的病史,并逐渐意识到右下肢无力和左下肢感觉异常。首次入院时的神经学检查显示为不完全性布朗 - 塞卡尔综合征。脊髓造影、脊髓CT和增强CT显示胸3 - 胸5水平髓内有一肿块。患者接受了椎板切除术并完全切除病变。病理诊断为海绵状血管瘤。6年后,患者主诉左上肢亚急性无力和麻木。头部CT显示右额叶有一个直径约2cm的高密度病变。MRI显示同一区域有一个混合信号强度病变,周边有明显的低信号环。对该病变进行了完全切除。脑内病变的病理诊断同样为海绵状血管瘤。髓内海绵状血管瘤非常罕见。此外,累及脊髓和脑的双灶性海绵状血管瘤极为罕见,文献中仅报道过5例。据我们所知,这是首例通过手术标本确诊的脊髓和脑内病变并存的病例。