J Korean Soc Spine Surg.  2012 Mar;19(1):20-24. 10.4184/jkss.2012.19.1.20.

Myelopathy due to Thoracic Intradural Extramedullary Tumor Misdiagnosed as the Cerebral Infarction: A Case Report

• Soh JW
• Lee JC
• Park SY
• Park JS
• Shin BJ

• KMID: 2097861
• DOI: http://doi.org/10.4184/jkss.2012.19.1.20

Abstract

STUDY DESIGN: A Case report.
OBJECTIVES
We report a case of thoracic intradural extramedullary tumor that has been misdiagnosed as the cerebral infarction. SUMMARY OF LITERATURE REVIEW: Spinal meningioma is one of the common spinal tumors. Clinical symptoms were characteristically progressive myelopathy, rather than radiculopathy.
MATERIALS AND METHODS
A 66-year-old female patient who had a history of cerebral infarction admitted as suffering from progressive lower extremities weakness for 6 months. The patient was diagnosed and has been treated as the cerebral infarction at another hospital. However, the patient showed worsening symptoms. In magnetic resonance imaging, an intradural extramedullary space occupying mass compressing the spinal cord, between T8 and T9 level, was shown. By undergoing an operation, resected the mass. In a pathologic report, mass was confirmed to be meningioma.
RESULTS
After the operation, symptoms were improved. The patient was able to walk 2 weeks after surgery.
CONCLUSIONS
We report the correct diagnosis and a successful surgical treatment of myelopathy, due to thoracic myelopathy that has been misdiagnosed as the cerebral infarction in another hospital.

Keyword

Thoracic; Intradural extramedullary tumor; Meningioma

MeSH Terms

Aged
Cerebral Infarction
Female
Humans
Lower Extremity
Magnetic Resonance Imaging
Meningioma
Spinal Cord
Spinal Cord Diseases
Stress, Psychological

Figure

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  Fig. 1. The tumor is located at the T8-9 level. (A) T1-weighted sagittal MR image shows peripheral low signal intensity and central iso-signal intensity mass. (B) T2-weighted sagittal MR image shows iso-signal intensity mass. (C) Gadolinium enhanced T1-weighted sagittal MR image shows high signal intensity mass. (D, E, F) T1, T2-weighted, Gadolinium enhanced T1-weighted axial MR image shows oval shape intradural extramedullary mass compressing spinal cord.

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  Fig. 2. (A) Intraoperative finding shows well exposed dural sac. (B) Intraoperative finding shows oval shape mass compressed spinal cord in dura matter.

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  Fig. 3. Gross finding of the tumor shows a well encapsulated ovoid mass including cartilage cap measured 1.2×1.2×1.0 cm.

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  Fig. 4. Follow-up MR image was checked for 4 weeks after operation. (A) T2-weighted sagittal MR image shows complete removal of cord compression lesion. (B, C) T2 and Gadolinium enhanced T1-weighted axial MR image shows complete removal of cord compression lesion.

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