Vertebral Hemangioma Causing Spinal Cord Compression
Eduardo de Pablo-Fernández, Cristina Dominguez-González
Canadian Journal of Neurological Sciences
A 62-year-old woman presented with a six-month history of progressive back pain, sensory disturbances and weakness in both lower limbs. On examination, there was a localized pain to palpation of lower thoracic vertebra, a mild spastic paraparesis with bilateral Babinski signs and altered sensation to the level of the umbilicus. Magnetic resonance imaging revealed a mixed hyper and isointense lesion on T1-weighted images and hyperintense on T2-weighted images involving the body of T8 with a
... culated appearance and foci of signal void. There was a soft tissue epidural extension of the lesion into the spinal canal with compression of the spinal cord that showed hyperintensity signal changes (Figure 1 and 2). These findings were consistent with a vertebral hemangioma (VH) causing a spinal cord compression. Preoperative embolization and surgical descompression with laminectomy and tumour resection were performed, with complete clinical recovery. The histological diagnosis was hemangioma of bone. Vertebral hemangiomas (VH) are relatively common benign vascular tumours usually asymptomatic, diagnosed as incidental findings during imaging studies. Rarely, their extraosseous extension can produce compressive neurological symptoms, although only few cases appear in the literature. The clinical presentation is characteristically insidious preceded by increased back pain, but acute onset may occur 1,2 . The most common location for symptomatic VH is the lower thoracic spine and women are more often affected than men 1,3 . Their more frequent magnetic resonance imaging features, although non-specific, are high signal intensity on both T1 and T2 weighted images Figure 1: Sagittal MR images showing a mixed hyper and isointense lesion on T1WI (left) and hyperintense signal on T2WI (centre and right), at T8 level. The vertebra is of normal height with trabeculated appearance and foci of signal voids (arrowheads). There is an extraosseous component of the lesion that extends into the spinal canal (right arrow) producing high signal intensity of the compressed spinal cord (left and central arrows).