Ergun Tarkan, Lakadamyali Hatice, Lakadamyali Huseyin, Mukaddem Amir
Department of Radiology, Alanya Teaching and Medical Research Center, Baskent University, Alanya, Turkey.
J Manipulative Physiol Ther. 2007 Oct;30(8):602-6. doi: 10.1016/j.jmpt.2007.06.007.
This case report presents a patient with acute compression myelopathy caused by acute hemorrhage of a thoracic vertebral hemangioma extending into the epidural space.
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.
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.
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.
本病例报告介绍了一名因胸椎血管瘤急性出血延伸至硬膜外间隙而导致急性压迫性脊髓病的患者。
一名22岁男性患者，背痛5个月，到我院就诊，主诉下肢突然出现麻木和肌肉无力。
胸椎磁共振成像显示T5水平有一肿块，主要累及椎体后部结构，延伸至硬膜外区域，钆增强明显。在肿块的硬膜外部分观察到出血性信号改变。此外，注意到硬膜外肿块部分明显压迫脊髓。该患者被转诊进行急诊手术，初步诊断为伴有出血成分的硬膜外椎体血管瘤；未进行术前血管造影即实施了减压椎板切除术。术后患者的症状完全改善，并对残留肿瘤组织进行了放射治疗。
急性或亚急性脊髓病症状的出现通常提示恶性肿瘤或转移。然而，在年轻患者中，鉴别诊断时应考虑到引起急性出血的椎体血管瘤。在这种情况下，应在神经症状变得不可逆之前进行减压手术。
