Matsushima K, Shinohara Y, Takizawa S, Yamamoto M
Department of Neurology, Tokai University, School of Medicine.
Rinsho Shinkeigaku. 1990 Feb;30(2):199-202.
A case of spinal ependymoma showing spinal subarachnoid hemorrhage with findings mimicking subacute meningitis is reported. A 33-year-old man was admitted to our hospital because of headache, low back pain and low grade fever on June 8, 1982. Ten years ago he had experienced an episode of abrupt onset lumbago and headache. Subarachnoid hemorrhage was suspected because of bloody cerebrospinal fluid, but cerebral angiography failed to demonstrate any abnormalities. On admission physical examination revealed nuchal rigidity, Kernig's sign and percussion tenderness on 5th lumbar spine. Lumbar puncture showed bloody cerebrospinal fluid. Cell counts were 217 per cubic millimeter (neutrophil: lymphocyte = 27.73), protein was 396 mg/dl and sugar level was 18 mg/dl. Myelography showed an intradural extramedullary tumor at the spinal level of L1-L2. Spinal MRI and CT scan also demonstrated a spinal tumor at the same level. Laminectomy and total resection of the spinal tumor were performed and a diagnosis of myxopapillary ependymoma was made histologically. He was discharged about a month later without any neurological deficits. The development of subarachnoid hemorrhage due to spinal tumor is rare. There are about 50 cases of spinal subarachnoid hemorrhage due to spinal tumor in the literature, including three cases in Japan. Two cases presenting CSF findings mimicking bacterial meningitis have been reported in the literature, but there is no report of subarachnoid hemorrhage due to spinal tumor that presents findings mimicking subacute meningitis similar to our case. From these results, it is suggested that subarachnoid hemorrhage due to spinal ependymoma may reveal various CSF findings. In cases suggesting bacterial or subacute meningitis with bloody CSF and acute onset, the possibility of spinal subarachnoid hemorrhage due to rupture of a spinal tumor, especially ependymoma, should be considered.
报告了一例脊髓室管膜瘤伴脊髓蛛网膜下腔出血，其表现酷似亚急性脑膜炎。一名33岁男性于1982年6月8日因头痛、腰痛和低热入住我院。10年前，他曾经历过一次突发腰痛和头痛。因脑脊液呈血性怀疑有蛛网膜下腔出血，但脑血管造影未显示任何异常。入院时体格检查发现颈项强直、凯尔尼格征阳性以及第5腰椎有叩击压痛。腰椎穿刺显示脑脊液呈血性。细胞计数为每立方毫米217个（中性粒细胞：淋巴细胞 = 27.73），蛋白为396mg/dl，糖水平为18mg/dl。脊髓造影显示L1 - L2脊髓水平有硬膜内髓外肿瘤。脊髓MRI和CT扫描也显示同一水平有脊髓肿瘤。进行了椎板切除术和脊髓肿瘤全切术，组织学诊断为黏液乳头型室管膜瘤。大约一个月后他出院，无任何神经功能缺损。脊髓肿瘤导致蛛网膜下腔出血很罕见。文献中约有50例脊髓肿瘤导致脊髓蛛网膜下腔出血的病例，其中日本有3例。文献中报道了2例脑脊液表现酷似细菌性脑膜炎的病例，但尚无类似我们病例的脊髓肿瘤导致蛛网膜下腔出血且表现酷似亚急性脑膜炎的报道。从这些结果来看，提示脊髓室管膜瘤导致的蛛网膜下腔出血可能有各种脑脊液表现。在脑脊液呈血性且急性起病提示细菌性或亚急性脑膜炎的病例中，应考虑脊髓肿瘤尤其是室管膜瘤破裂导致脊髓蛛网膜下腔出血的可能性。
