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Rezidivierende Subarachnoidalblutung bei spinalem Neurinom
Abstract
Es wird über einen ungewöhnlichen Fall von rezidivierender Subarachnoidalblutung berichtet, die durch ein gutartiges, im Kaudabereich gelegenes Neurinom mit Blutzufuhr über eine akzessorische, stark dilatierte Arterie verursacht wurde.
Nach längerer Vorgeschichte mit wiederholten Beschwerden im Lendenwirbelbereich wurde nach Auftreten einer zerebralen Akutsymptomatik zunächst eine Subarachnoidalblutung ungeklärter Ätiologie diagnostiziert. Erst durch die Rezidivblutung wurde der spinale Tumor entdeckt. Unter Berücksichtigung weiterer Fälle aus der Literatur werden Auslösemechanismus und diagnostische Problematik bei Subarachnoidalblutungen infolge eines Rückenmarkstumors erörtert.
Summary
An unusual case of recurrent subarachnoid haemorrhage caused by a benign neurinoma in the region of the cauda equina is reported, in which the tumour was supplied by an accessory dilated artery. After recurrent complaints in the lumbar region an acute cerebral symptomatology first led to the diagnosis of a subarachnoid haemorrhage of unknown aetiology. It was only the recurrence of the bleeding which enabled the tumour to be detected.
Other cases from the literature of subarachnoid haemorrhage due to spinal tumours are considered and the mechanism of bleeding and diagnostic problems are discussed.
抄録
Spinal subarachnoid hemorrhage (SAH) has the most common occurrence due to A—V malformation, but SAH from the spinal cord tumor is well documented. A case of SAH due to neurinoma of the spinal cord is reported. This case experienced the sudden onset ofsharp low back pain with radiation to both hips, and had the increasing loss of power. The early laminectomy revealed the neurinoma of the spinal cord at conus with intracapsular hematoma, and the extirpation of the tumor decreased the neurological deficit.
Acute paraplegia due to the intratumour haemorrhage of spinal neurofibroma is a rare condition. We describe 2 patients with this unusual presentation. Surgical treatment was successful in both patients. These 2 cases are reported, and the literature is reviewed.
A rare observation of spinal neurinoma associated with subarachnoid hemorrhage is reported and the other 12 cases in the literature are reviewed. The extramedullary location of the tumor and the feeble arachnoidal attachments to the spinal cord favor subarachnoidal bleeding in these cases. When the meningeal signs are evident and signs of spinal cord impairment are still unclear, an intracranial origin of the bleeding must be excluded. In doubtful cases, selective spinal angiography is useful in the differential diagnosis between a bleeding spinal tumor and an arteriovenous malformation of the spinal cord.
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