Paraplegia caused by intratumoral hemorrhage within thoracic epidural granuloma.

An 84-year-old man presented with a rare case of spinal epidural granuloma with intratumoral hematoma resulting in acute paraplegia. He was admitted to our hospital because of lumbago and hematemesis following a fall 10 days before. Progressive paraparesis occurred 2 days after admission. Neurological examination showed paraplegia and hypesthesia below the T10 level. Thoracic radiography revealed some spondylotic changes of the thoracic vertebrae without osteolytic changes. Sagittal T(1)- and T(2)-weighted magnetic resonance imaging of the thoracic spine demonstrated a hyperintense epidural mass lesion compressing the dorsal portion of the thoracic spinal cord at T10-11 space. Emergency laminectomy was performed, and the epidural encapsulated hematoma and elastic yellowish mass adhered to the dura mater were totally removed. Histological examination of the excised specimens showed a granuloma. Motor weakness improved after surgery, and he could walk with a cane about 3 months after surgery. The minor spinal injury probably caused intratumoral hemorrhage within a previous epidural granuloma, suddenly resulting in the paraplegic symptoms.