Abstract
There is a range of differential diagnoses for intramedullary lesions of the conus
medullaris, both neoplastic and non-neoplastic. There is a limited role for surgery
in a large proportion of these diagnoses, and operative risks can outweigh any benefits
of surgery. Here a case is presented of a patient referred to a neurosurgical center
for a biopsy of a presumed neoplastic conus tumor. However, through the collaboration
of a multidisciplinary team, further diagnoses were considered. After thorough investigation,
two conditions were diagnosed: venous congestive myelopathy secondary to inferior
vena cava agenesis and spinal neurosarcoidosis. This case demonstrates the importance
of neurosurgeons retaining a high degree of suspicion for alternative diagnosis to
avoid unnecessary surgical risk.
Keywords
neurosarcoidosis - venous congestive myelopathy - cauda equina - intramedullary -
myelopathy
