Gendle et al. reported an unusual case of thoracolumbar intramedullary CM with hemorrhage in a 5-month-old male child.
The child presented with the predominant symptom of urinary retention, and the underlying neurological cause was initially overlooked. However, magnetic resonance imaging obtained after the onset of progressive limb weakness revealed a D11-L1 intramedullary lesion with features of intralesional bleed. Intraoperatively, the lesion showed evidence of hemorrhage and was completely excised. The final histopathology confirmed a cavernoma.
Although rare, spinal CM can present with bleed in very young children. It is imperative to identify the subtle clinico-radiological findings and suspect such lesions, as an early treatment portends a good outcome 1).
A 56-year-old male presented with sensory changes in his right hand, which rapidly progressed over ensuing weeks to bilateral sensory changes in the upper and lower limbs, gait imbalance, urinary and faecal incontinence and loss of temperature perception. He subsequently developed significant weakness in the upper limbs. A MRI identified a hematoma in the cervical cord at the C2 level. Given his rapid neurological decline and the social and clinical implications of his bladder and bowel instability, a surgical approach to therapy was adopted.
Postoperatively, there was steady improvement in motor and sensory function and a complete return of bladder and bowel function.
Intramedullary spinal cord cavernomas, although rare, can cause significant neurological deficits and morbidity. Surgical excision can provide significant benefits, including restoration of bladder and bowel function 2)