Thoracic vertebral hemangioma causing lower limb spastic paresis Tariq ALOTAIBI¹ Mohammed alfawarehMD² 1King Saud university Riyadh Saudi Arabia 2Consultant of orthopedic and spine surgery Spine ID: 547935
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Case report Thoracic vertebral hemangioma causing lower limb spastic paresis
Tariq ALOTAIBI¹Mohammed alfawareh.MD²
1.King Saud university, Riyadh ,Saudi Arabia
2.Consultant of
orthopedic and spine
surgery ,Spine
surgery department
,National
neuroscience institute
,King
Fahad medical citySlide2
What is vertebral hemangioma?Slow growing intraosseous vascular tumorBenign in origin
Histologically, it has 3 types: capillary, cavernous and Mixed
Causing local compression if aggressive (rare)Slide3
Introduction The most common benign vertebral tumor
Incidental finding on autopsyAsymptomatic in adult
Symptomatic in children with few cases reported
Rarely symptomatic
in
adult (0.9-1.2)
McAllister
VL, Kendall BE, Bull JW. Symptomatic vertebral
hemangiomas.
Brain. 1975;98 (1): 71-80
.
Murugan
L, Samson RS, Chandy MJ (2002) Management
of symptomatic
vertebral hemangiomas: review of 13
patients Neurol
India 50(3):300–305Slide4
Thoracic vertebral hemangioma are more
commonMore likely to be symptomatic
Incidence about 10-12%
Aich
RK, Deb AR, Banerjee A, Karim R, Gupta P (2010)
Symptomatic vertebral
hemangioma: treatment with radiotherapy. J Cancer Res Ther 6:199–203
Nassar
SI, Hanbali FS, Haddad MC, Fahl MH (1998)
Thoracic vertebral
hemangioma with extradural extension and spinal
cord compression
. Case report. Clin Imaging 22(1):65–68Slide5
Case reportEighteen years old
MaleOne month history of radiating mid thoracic back pain
lower
limb
weakness
Decreasing
sensation in both lower legsSlide6
Physical ExaminationLower limbs power was decreased; 3/5 all over
Exaggerated deep tendon reflexes, with bilateral sustained
clonus
Sensation was impaired below T 10, there was bilateral spasticity
and Babinski signSlide7
Radiological Imaging X ray
Plain
x-ray of the spine showed the lesion at T8 with vertical
trabeculation
(jail bar appearance
)T
here
is mild scoliotic deformity with convexity toward the right
sideSlide8
CT scan
CT without contrast showed diffuse T8 body coarse
trabeculation
referred as
(corduroy cloth) sign Slide9
Axial
view
There
is an expansion of the body and
laminas
causing spinal
stenosis
Trabiculation seen as
(polka
dot sign
.)
Tumor
was extending to both pedicles, laminas and the base of the transverse processes
bilaterallySlide10
MRI
T8 extensive high signal intensity body lesion on T2 , T1 and stained with contrast
Tumor
extending to the neuronal canal causing mass effect over spinal cord at that
levelSlide11
ManagementDecompression and fixation from T5 through T 10
on an emergency basesPermanent biopsy samples reported as blood vessels proliferation
and
dilated spaces with no malignant cells
consistent with
HemangiomaSlide12
Post-opUneventful post-op recovery
Spasticity; improved over timePower; returning to normalSlide13
RehabilitationPatient was referred to rehabilitation and recovered near complete after 6 weeks of extensive physiotherapy and rehabilitation
Discharged walking
independently
Minimal
weakness and near normal
sensationsSlide14
DiscussionMost vertebral hemangiomas are asymptomatic which require no treatmentT
he most common presenting symptom is back pain Radiological diagnosis (CT is the gold standard )
Spastic
para-paresis
in our case reflects an aggressive hemangioma, which can result in permanent paraplegia if not managed appropriately
Hiari A, Nawaiseh B, Jaber H (1998) Magnetic resonance
imaging in
the diagnosis of vertebral haemangiomas. East Mediterr
Health J
4(1):
149–155
Laredo JD, Reizine D, Bard M, Merland JJ. Vertebral
hemangiomas:
radiologic evaluation. Radiology. 1986;161(1):183–9.Slide15
ConclusionYoung age back
pain!Rare but can present with sever symptoms
Full recovery if managed appropriately
Needs high index of suspension, malignant?