Sumayya naz1, Khaled Gharaibeh1, Sidra saleem1, Naeem Mahfooz2
1Neurology, University of Toledo Medical College, 2Neurology, University of Toledo Medical college
Objective:
Cavernous angioma can occur in pediatrics throughout the central nervous system. However, the intramedullary spinal cord accounts for just 1% of all intramedullary pediatric spinal cord lesions
Background:
Cavernous angiomas consist of enlarged, packed vessels without interposition of the normal brain parenchyma. In addition, surrounding hemosiderin deposits and gliosis, and sometimes calcifications can be noted. The clinical presentation in pediatrics is usually characterized by acute neurologic decline that occurs because of acute hemorrhage with extension into the spinal parenchyma, rather than gradual onset of myelopathy as we see in adults. The most widely used diagnostic tool for detecting cavernous angiomas is MRI. Unfortunately, MRI can be negative before the occurrence of bleeding.
Design/Methods:
We report a 13-year-old female presented with 3-day history of worsening back pain associated with bilateral lower extremities, weakness, excruciating pain, tenderness and paresthesia. In addition, she also reported urinary retention. On admission, her motor power grade was 2/5 (Medical Research Council Scale for Muscle Strength) in both lower limbs with absent deep tendon reflexes and sever asymmetrical sensory loss below the T7 dermatome bilaterally. Initial MRI neuroaxis showed enhancing 12 mm focal nodular lesion at T10 level with perilesional edema. Twelve hours later, the patient had acute worsening in her strength, on examination of her motor strength was found to be 0/5 (MRC). Repeat imaging showed expansion of hemorrhage. She underwent T9-T11 laminectomy for resection of the spinal cord lesion. On the gross examination benign lesion with abnormal vascular anatomy was identified. Histology was consistent with cavernous angioma with reactive changes.
Conclusions:
Cavernous angiomas are considered as rare cause for intramedullary pediatric spinal cord lesions. It still should be considered as one of the differentials for acute flaccid paralysis. Early surgical intervention and resection should be considered early whenever feasible.