Gandhoke C S, Syal S K, Singh D, Batra V, Nallacheruvu Y
Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and G. B. Pant Institute of Postgraduate Medical Education and Research (G.I.P.M.E.R.), New Delhi, India.
Department of Paediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India.
Surg Neurol Int. 2018 Jul 24;9:142. doi: 10.4103/sni.sni_171_18. eCollection 2018.
Spinal schwannomas are slow growing, benign nerve sheath tumors. These may be asymptomatic or may present as backache with radicular pain, slowly progressive neurological deficits, but rarely with acute spastic quadriparesis attributed to intratumoral hemorrhage.
A 38-year-old male presented with the chief complaint of neck pain radiating to the left upper extremity for the last 8 months. On admission, he exhibited diffuse hyper-reflexia but had no motor or sensory deficit. Magnetic resonance imaging showed a solid-cystic intradural extramedullary (IDEM) C2 to C4 mass severely compressing the spinal cord. The same day the patient acutely developed a spastic quadriparesis. Immediately, a partial C2, C3, and C4 laminectomy was performed for tumor excision; within 5 postoperative days, he fully regained neurological function. The final histopathology was consistent with a "schwannoma showing areas of congestion and hemorrhage."
Spinal schwannomas rarely present with intratumoral hemorrhage and acute spastic quadriparesis. Immediate operative decompression may lead to excellent postoperative neurological recovery.
脊髓神经鞘瘤是生长缓慢的良性神经鞘瘤。这些肿瘤可能无症状，或表现为伴有神经根性疼痛的背痛、缓慢进展的神经功能缺损，但很少因肿瘤内出血导致急性痉挛性四肢瘫。
一名38岁男性，主要诉求为过去8个月颈部疼痛并向左上肢放射。入院时，他表现为弥漫性反射亢进，但无运动或感觉障碍。磁共振成像显示C2至C4水平有一个实性囊性硬膜内髓外（IDEM）肿块，严重压迫脊髓。同一天，患者急性出现痉挛性四肢瘫。随即进行了C2、C3和C4部分椎板切除术以切除肿瘤；术后5天内，他完全恢复了神经功能。最终组织病理学结果与“显示充血和出血区域的神经鞘瘤”一致。
脊髓神经鞘瘤很少出现肿瘤内出血和急性痉挛性四肢瘫。立即进行手术减压可能导致术后神经功能极佳的恢复情况。
