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An unusual case of proctalgia
B Rappaport1, H A Emsellem, R Shesser
1Department of Neurology, George Washington University Medical Center, Washington, DC.
Annals of Emergency Medicine
|February 1, 1990
Summary
Sudden rectal pain in a young man was linked to a spinal tumor causing subarachnoid hemorrhage. Prompt diagnosis and surgical removal of the myxopapillary ependymoma led to a favorable outcome.
Area of Science:
- Neurology
- Neurosurgery
- Oncology
Background:
- Subarachnoid hemorrhage (SAH) is a critical neurological condition often associated with vascular abnormalities.
- Proctalgia, or rectal pain, is not a typical presenting symptom of SAH, posing diagnostic challenges.
Observation:
- A 21-year-old male presented with acute severe proctalgia, followed by headaches and fever.
- Initial investigations revealed SAH, but cerebral angiography was normal.
- Spinal imaging identified an L1 level mass lesion.
Findings:
- Surgical resection and pathological analysis confirmed the mass as a myxopapillary ependymoma.
- Hemorrhage from this spinal tumor was the cause of the SAH.
- Myxopapillary ependymomas are typically benign tumors of the cauda equina and filum terminale.
Implications:
- This case highlights the importance of considering spinal pathology in the differential diagnosis of unexplained SAH, even with atypical presenting symptoms like proctalgia.
- Emergency physicians should maintain a high index of suspicion for spinal subarachnoid hemorrhage in patients with acute rectal pain.
- Early diagnosis and treatment of spinal ependymomas can lead to good patient outcomes.