Spinal cord tumor clinical features

The clinical presentation of primary spinal cord tumors is determined in part by the location of the tumor, and in nearly all clinical instances pain is the predominant presenting symptom. Motor disturbance is the next most common symptom, followed by sensory loss.

The clinical signs and symptoms of these tumors are due to mass effect and neurological dysfunction ¹⁾.

The lack of any specific clinical characteristic often precludes early diagnosis of the lesion and results in most patients being diagnosed with advanced neurological impairments such as paralysis and bladder incontinence ²⁾.

Pain: the most common complaint. Almost always present in filum terminale tumors (exception: lipomas).

Possible pain patterns:

a) radicular:increases with Valsalva maneuver and spine movement.Suspect SCT if dermatome is unusual for disc herniation

b) local:stiffneckorback,Valsalvamaneuverincreasespain.

★ Pain during recumbency (“nocturnal pain”) is classic for SCT

c) medullary (as in syrinx): oppressive, burning, dysesthetic, non-radicular, often bilateral, unaf- fected by Valsalva maneuver

van der Hoeven et al. from Hagaziekenhuis, The Hague, and Leiden The Netherlands, present the case of a woman who developed severe nightly thoracic pain during pregnancy without neurological deficits upon examination. Spontaneously after childbirth, the pain was markedly reduced. Further investigation showed that her pain was caused by an intramedullary ependymoma in the cervicothoracic spinal cord. Gross total resection was accomplished, and the patient has been free of pain ever since. With this case, the authors want to draw attention to a rare, but possibly very disabling, cause of increasing nightly thoracic pain during pregnancy. Spontaneous improvement after childbirth could erroneously cause postponement of further investigation ³⁾.

a) weakness is 2nd or 3rdmost common complaint. Usually follows sensory symptoms temporally

b) children present most frequently with gait disturbances

c) syringomyelic syndrome: suggests IMSCT. Findings: UE segmental weakness, decreased DTR, dissociative anesthesia

d) long-tractinvolvement→clumsiness and ataxia(distinct from weakness)

e) atrophy,muscle twitches,fasciculations

a) dissociated sensory loss:decreased pain and temperature,preserved light touch,as in Brown-Séquard syndrome. There is disagreement whether this is common or uncommon

in IMSCT. ± non-radicular dysesthesias (early), with upward extension b) paresthesias:either radicular or “medullary” distribution

a) usually urogenital(anal less common)→difficulty evacuating,retention,incontinence,and impotence. Early in conus/cauda equina lesions, especially lipomas (pain not prominent)

b) sphincter dysfunction common in age<1yr due tofrequency of lumbosacral lesions(dermoids, epidermoids, etc.)

a) scoliosis or torticollis

b) SAH

c) visible mass over spine

Onset usually insidious, but abruptness occurs (benign lesions in children occasionally progress in hours). The onset is often erroneously attributed to coincidental injury. Temporal progression has been divided into 4 stages:

1. pain only (neuralgic)

2. Brown-Séquard syndrome

3. incomplete transectional dysfunction

4. complete transectional dysfunction

Note: 78% (of 23) ependymomas, 74% (of 42) gliomas, all 7 dermoids, and 50% (of 8) lipomas reached the latter 2 stages before diagnosis (not affected by location in cross-sectional nor longitudinal dimension of SC (excludes conus lesions—more frequently diagnosed in 1st stage) (a pre-CT study)).