Multiple neurilemmomas of the cauda equina, cavernous hemangioma of the spinal cord, and degeneration of the lateral corticospinal tracts in a man with the clinical diagnosis of multiple sclerosis.

Clinical and neuropathological findings of a 72-year-old man are reported who was thought to have had multiple sclerosis for 44 years. The main clinical symptom was a slowly progressive spastic tetraparesis, but during the last years he also developed bilateral neurogenic deafness, dysfunction of the urinary bladder and loss of vibratory and positional sensation in the legs. Autopsy revealed a unique combination of neuropathological findings, namely 1) multiple neurilemmomas of the cauda equina with loss of nerve fibers in dorsal roots and Goll's tracts, 2) symmetric fiber loss in the lateral corticospinal tracts throughout the spinal cord, and 3) a cavernous hemangioma of the lower thoracic spinal cord. No changes of multiple sclerosis were found. It is postulated that the patient may have had both neurofibromatosis and a sporadic or familial form of primary lateral sclerosis. The hemangioma in the spinal cord is probably unrelated to these two conditions, although it cannot be excluded that it represents a manifestation of von Recklinghausen's disease.