Tanki Humam, Singh Harshita, Raswan Uday S, Bhat Abdul R, Saija Yagnesh, Kirmani Altaf R, Javaid Iqbal
Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India.
Department of Ophthalmology, Dr. Manzoor Eye Care Centre, Jammu and Kashmir, India.
J Pediatr Neurosci. 2018 Oct-Dec;13(4):503-507. doi: 10.4103/JPN.JPN_83_18.
Pediatric spinal schwannomas/neurofibromas constitute only 2.5%-4% of all pediatric spinal tumors. However, subarachnoid hemorrhage (SAH) because of spinal pathologies is very rare, representing 1.5% of all cases of SAH. Spinal nerve sheath tumors such as schwannomas rarely present with SAH, especially before the appearance of overt signs of spinal cord or root compression. We report a case of dorsolumbar schwannoma in an 11-year-old girl presenting clinically with signs and symptoms mimicking meningitis, but meningeal signs later proved to be due to SAH associated with spinal (D12-L1) schwannoma and hydrocephalus. Mass was excised and ventriculoperitoneal shunt was inserted. In our clinical practice, we may sometimes come across some uncommon diseases with even more uncommon presentations as happened with us at our institute. We must always consider that there is a possibility of SAH owing to silent spinal lesion in patients with angiographic negative intracranial SAH as in this case.
小儿脊髓神经鞘瘤/神经纤维瘤仅占所有小儿脊髓肿瘤的2.5%-4%。然而,因脊髓病变导致的蛛网膜下腔出血(SAH)非常罕见,占所有SAH病例的1.5%。神经鞘瘤等脊髓神经鞘膜肿瘤很少出现SAH,尤其是在出现脊髓或神经根压迫的明显体征之前。我们报告一例11岁女孩的背腰部神经鞘瘤,临床症状和体征类似脑膜炎,但后来证明脑膜刺激征是由与脊髓(D12-L1)神经鞘瘤及脑积水相关的SAH所致。切除了肿块并插入了脑室腹腔分流管。在我们的临床实践中,有时可能会遇到一些不常见的疾病,其表现更为罕见,就像我们在研究所遇到的这种情况。我们必须始终考虑到,如本例中血管造影阴性的颅内SAH患者,有可能因隐匿性脊髓病变而发生SAH。