J Manipulative Physiol Ther 2007 Oct;30(8):602-6
Department of Radiology, Alanya Teaching and Medical Research Center, Baskent University, Alanya, Turkey.
Objective: This case report presents a patient with acute compression myelopathy caused by acute hemorrhage of a thoracic vertebral hemangioma extending into the epidural space.
Clinical Features: A 22-year-old male patient experiencing back pain for 5 months presented to our medical facility complaining of sudden onset numbness and muscle weakness in the lower extremities.
Intervention And Outcome: Magnetic resonance imaging of the thoracic spine revealed a T5-level mass involving predominantly the posterior vertebral elements, extending into the epidural area, and showing significant gadolinium enhancement. Hemorrhagic signal changes were noted within the epidural component of the mass. In addition, the epidural mass component was noted to significantly compress the spinal cord. The patient was referred for emergency surgery with the preliminary diagnosis of epidural vertebral hemangioma with hemorrhagic component; a decompression laminectomy was performed without preoperative angiography. The patient's complaints improved completely after surgery, and radiotherapy was instituted for the residual tumor tissue.
Conclusion: The presence of acute or subacute myelopathic symptoms is usually suggestive for malignancy or metastasis. However, in young patients, vertebral hemangioma, causing acute hemorrhage, should be considered in the differential diagnosis. Decompression surgery should be done in such cases before neurological symptoms become irreversible.