Cervical Schwannoma camouflaged by cervical intervertebral disc prolapse-A case report.

IF 0.7 Q4 CLINICAL NEUROLOGY
Shailesh R Hadgaonkar, Nishad V Situt, Shivan Marya, Siddharth N Aiyer, Parag K Sancheti
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Abstract

Introduction: Cervical prolapsed intervertebral disc is one of the common conditions causing cervical myeloradiculopathy. Anterior Cervical Discectomy and Fusion (ACDF) is the standard line of management for the same. Intradural neurogenic origin tumors are relatively rare and can present with features of myeloradiculopathy. Radiological imaging plays important role in diagnosis of such pathologies.

Case report: We report a patient with C5-6 cervical disc prolapse that presented with radiculopathy symptoms in the right upper limb, which was refractory to conservative care. He underwent a C5-6 ACDF and reported complete relief from symptoms at 4 weeks. He developed deteriorating symptoms over the next 10 weeks and presented at 14 weeks follow-up with severe myeloradiculopathy symptoms on the left upper limb with upper limb weakness. A fresh MRI identified an intradural extramedullary tumor with cystic changes at the index surgery level. This was treated with tumor excision and histopathology confirmed a diagnosis of schwannoma. Simultaneous presence of cord signal changes with disc herniation obscured the cystic schwannoma which became apparent later on contrast enhanced MRI imaging.

Conclusion: Careful review of preoperative imaging and contrast MRI study may help in diagnosing cystic schwannomas with concomitant cervical disc herniations that have cord signal changes.

Abstract Image

颈椎间盘突出伪装的神经鞘瘤一例报告。
引言:颈椎间盘突出症是引起颈椎神经根型病变的常见疾病之一。颈前路椎间盘切除融合术(ACDF)是此类手术的标准治疗方法。硬膜内神经源性肿瘤相对罕见,可表现为脊髓神经根病的特征。放射影像学在此类疾病的诊断中起着重要作用。病例报告:我们报告了一名C5-6颈椎间盘突出症患者,其右上肢出现神经根病症状,保守治疗难以治愈。他接受了C5-6 ACDF,并报告在4周时症状完全缓解。在接下来的10周内,他出现了恶化的症状,并在14周的随访中出现了严重的左上肢脊髓神经根病症状和上肢无力。一个新的核磁共振成像发现了一个髓外硬膜内肿瘤,在指数手术水平上有囊性变化。经肿瘤切除治疗,组织病理学诊断为神经鞘瘤。脊髓信号变化与椎间盘突出同时存在,使囊性神经鞘瘤变得模糊,这在后来的对比增强MRI成像中变得明显。结论:仔细回顾术前影像学和对比MRI研究可能有助于诊断伴有脊髓信号变化的囊性神经鞘瘤合并颈椎间盘突出症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Spinal Cord Series and Cases
Spinal Cord Series and Cases Medicine-Neurology (clinical)
CiteScore
2.20
自引率
8.30%
发文量
92
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