Malbrain M L, Kamper A M, Lambrecht G L, Hermans P, Baeck E, Verhoeven F, Wyffels G, Verbraeken H
Department of Neurology, Stuivenberg General Hospital, Antwerpen.
Acta Neurol Belg. 1994;94(1):35-43.
A 65 year-old woman with a filum terminale ependymoma is reported, presenting with acute cauda equina compression syndrome due to intratumoural and subsequent spinal subarachnoid hemorrhage (SAH) following therapy with oral anticoagulants. Few cases of spinal ependymoma have been reported with an acute cauda equina compression syndrome as the initial and only symptom, and the unique feature of our patient's anticoagulant status has only been described once in this setting. Although intratumoural hemorrhage is very well known since the myxopapillary variant is unique to the cauda equina and consists of loose connective tissue and numerous small blood vessels that are prone to bleeding, spinal SAH is seldom seen and the different hypotheses about the pathophysiological mechanisms that might promote bleeding still remain unresolved and will be discussed in this paper, as well as the special clinical features of spinal SAH and some diagnostic and therapeutic implications. A review of the literature (Medline search 1983-1993) revealed only 13 cases, including ours, of spinal SAH due to cauda equina ependymoma, and the results of this review together with our findings are described in this paper.
本文报道了一名65岁患有终丝室管膜瘤的女性患者，其因肿瘤内出血以及口服抗凝剂治疗后发生脊髓蛛网膜下腔出血（SAH），进而出现急性马尾神经压迫综合征。鲜有报道脊髓室管膜瘤以急性马尾神经压迫综合征作为首发且唯一症状，而我们这位患者的抗凝状态这一独特特征在该情况下仅被描述过一次。尽管肿瘤内出血广为人知，因为黏液乳头型是马尾神经所特有的，由疏松结缔组织和众多易出血的小血管组成，但脊髓SAH却很少见，关于可能促发出血的病理生理机制的不同假说仍未得到解决，本文将对此进行讨论，同时还将探讨脊髓SAH的特殊临床特征以及一些诊断和治疗意义。对文献（1983 - 1993年Medline检索）的回顾显示，包括我们的病例在内，仅有13例因马尾神经室管膜瘤导致脊髓SAH的病例，本文将描述此次回顾的结果以及我们的发现。
