Silsby Matthew, Varikatt Winny, Vucic Steve, Menon Parvathi
Neurology, Westmead Hospital, Westmead, New South Wales, Australia.
Anatomical Pathology, Westmead Hospital, Westmead, New South Wales, Australia.
BMJ Neurol Open. 2021 Jun 14;3(1):e000147. doi: 10.1136/bmjno-2021-000147. eCollection 2021.
Headache due to raised intracranial pressure is rarely caused by spinal lesions. We describe a patient with primary histiocytic sarcoma who presented with a new onset headache with features of raised intracranial pressure and subtle signs of cauda equina syndrome due to predominant lower spinal cord infiltration and minimal intracranial involvement.
A previously well 54-year-old man presented with a 2-month history of new onset headache with features of raised intracranial pressure. Progression of lower limb weakness was delayed and mild with diagnostic delay resulting from the primary presentation with headache leading to an initial focus on cerebral pathology. Subsequent investigations revealed a previously unreported presentation of primary histiocytic sarcoma infiltrating the cauda equina causing raised intracranial pressure headache.
This case highlights the importance of a broad search in the investigation of new onset raised intracranial pressure headache, including imaging of the lower spinal cord. Primary histiocytic sarcoma should be considered in the differential diagnosis of this rare syndrome.
颅内压升高所致头痛很少由脊柱病变引起。我们描述了一名原发性组织细胞肉瘤患者，该患者出现新发头痛，具有颅内压升高的特征以及马尾综合征的细微体征，原因是主要为脊髓下段浸润且颅内受累 minimal。
一名既往健康的 54 岁男性，有 2 个月新发头痛病史，伴有颅内压升高的特征。下肢无力进展延迟且轻微，因最初以头痛为主诉导致诊断延迟，最初聚焦于脑部病变。后续检查发现原发性组织细胞肉瘤一种先前未报道的表现形式，浸润马尾导致颅内压升高性头痛。
本病例强调了在新发颅内压升高性头痛的调查中进行广泛检查的重要性，包括脊髓下段成像。在这种罕见综合征的鉴别诊断中应考虑原发性组织细胞肉瘤。
