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Spinal subarachnoid hemorrhage during myelography. Case report
Journal of Neurosurgery
|April 1, 1978
Summary
Spinal tumors like neurofibromas can cause subarachnoid hemorrhage (SAH), a rare but serious complication. This case highlights a unique presentation of spinal SAH during diagnostic imaging for suspected disc disease.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Neoplasms in the conus medullaris and cauda equina are known causes of subarachnoid hemorrhage (SAH).
- Hemorrhage is often the initial presenting symptom in these cases.
- Spinal tumors can present diagnostic challenges, especially when symptoms mimic more common conditions.
Observation:
- A patient with a T12-L1 neurofibroma presented with spinal subarachnoid hemorrhage (SAH).
- The SAH occurred during myelography, initially performed to investigate suspected lumbar disc disease.
- Radiographic findings uniquely showed the neurofibroma preceding the subarachnoid clot.
Findings:
- The neurofibroma at T12-L1 was identified as the source of the spinal SAH.
- The hemorrhage mechanism is hypothesized to involve shearing of bridging capsular veins.
- This shearing may result from reduced cerebrospinal fluid pressure below the obstructing tumor.
Implications:
- This case underscores the importance of considering intraspinal neoplasms in the differential diagnosis of SAH.
- Diagnostic imaging protocols may need to be adjusted for patients with unexplained SAH.
- Understanding the mechanism of hemorrhage can aid in surgical planning and patient management.