Anomalous hemorrhage in myxopapillar ependymoma: illustrative case

This is the case of a 22-year old male with bilateral leg pain caused by an intradural lesion at the L3 level. On MRI, there were no signs of hemorrhage. Resection was performed and a raspberry-like lesion with attached veins was identified. Histopathological analysis showed a myxopapillary ependymoma.

Although hemorrhage is rare, myxopapillary ependymomas are highly vascularized and carry the highest risk of intratumoral bleeding among spinal ependymomas. In the literature, most patients with hemorrhage of myxopapillary ependymomas present with neurological deterioration. Rarely are these patients noted to be clinically stable.

Despite no worsening of symptoms or preoperative evidence of hemorrhage, intraoperative findings revealed a hemorrhagic lesion attached to vascular structures and potentially the filum terminale. Hemorrhage in a myxopapillary ependymoma without clinical deterioration is a rare occurrence. https://thejns.org/doi/10.3171/CASE25791.