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Clival chordoma presenting with acute brain stem hemorrhage
A D Levi1, W Kucharczyk, A P Lang
1Department of Neuroradiology, Toronto Hospital, University of Toronto, Ontario, Canada.
Summary
A rare clival chordoma caused brainstem hemorrhage, leading to cranial nerve palsies and hemiparesis. Advanced imaging and surgery enabled a successful outcome in this first reported case.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Radiology
Background:
- Clival chordomas are rare bone tumors originating from notochordal remnants.
- Brainstem invasion and hemorrhage are exceptionally uncommon presentations of clival chordomas.
Observation:
- A 29-year-old male presented with acute cranial nerve palsies and right hemiparesis.
- Clinical symptoms were attributed to a pontine hemorrhage.
Findings:
- Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a clival chordoma invading the brainstem with associated hemorrhage.
- Surgical decompression via sub-occipital craniotomy successfully removed the tumor and clot from the pons.
Implications:
- This case highlights the importance of considering rare diagnoses like clival chordoma in patients with unexplained brainstem hemorrhage.
- Preoperative diagnosis through advanced neuroimaging is crucial for effective surgical management and patient survival.
- This represents the first documented case of a clival chordoma presenting with and diagnosed due to brainstem hemorrhage.