A 29-year old arabian man was admitted to the hospital with a progressive sensory
loss to light touch, pin prick and vibration of the right and in a lesser extent of
the left leg without any association to a particular dermatome. He additionally presented
with paraesthesias in both legs, unsteady gait and incipient bladder- and bowl incontinence
starting approximately one week prior to admission. Examination of reflexes revealed
a diminished achilles tendon reflex in combination with a hyperactive patellar tendon
reflex bilaterally. Cerebral spinal fluid (CSF) analysis showed 8 cells/µl, 39mg/dl
protein, and 64mg/dl glucose. No immunological evidence for viral, bacterial or fungal
infection could be found.
Subsequently performed spinal MRI showed a central intramedullary lesion approximately
1cm in diameter located within the conus medullaris suspicious for an intramedullary
cavernous malformation (A-E). The lesion was accompanied by a perifocal edema and
showed an inhomogeneous hypointense core on T2WI consistent with an cavernous hemorrhage
(A,D,E). Application of contrast agent showed a slight enhancement in the edematous
region (C) (Figure 1).
Cavernous malformations may be localized in every region of the CNS. Spinal cord cavernous
malformations (SCCM) have been diagnosed more frequently since magnetic resonance
imaging (MRI) has become more widely available. While the true incidence of SCCM remains
unknown, they represent about 5–12% of all spinal vascular abnormalities1. They are
rarely found in the conus medullaris representing only around 3% of all intramedullary
cavernomas. Most are asymptomatic. The treatment of choice for symptomatic spinal
cord cavernous malformations appears to be surgical excision in order to avoid recurrent
bleeding. Consequently, the patient was referred to the department of neurosurgery
with following total surgical excision. He had complete functional recovery after
approximately four weeks.
