High-Grade Glioma of the Caudal Part of the Spinal Cord Mimicking Myelitis – a Case Report

Česká verze

Authors: M. Škorňa ¹; J. Bednařík ^1,2; M. Smrčka ³; P. Štourač ^1,2; C. Macháček ⁴; A. Šprláková-Puková ⁵; P. Krupa ⁶
Authors place of work: Neurologická klinika LF MU a FN Brno ¹; CEITEC MU, Brno ²; Neurochirurgická klinika LF MU a FN Brno ³; Ústav patologie LF MU a FN Brno ⁴; Radiologická klinika LF MU a FN Brno ⁵; SurGal Clinic, Brno ⁶
Published in the journal: Cesk Slov Neurol N 2013; 76/109(1): 104-109
Category: Kazuistika

Summary

Spinal cord glioblastomas are very rare tumours constituting only about 1.5% of all primary spinal cord malignancies. This case report presents a 20-year-old man with high-grade glioma of the caudal part of the spinal cord. Progression and magnetic resonance imaging (MRI) finding were atypical with rapidly advancing secondary changes to the spinal cord. The outcome was fatal. The patient was admitted with a history of two-month progression of weakness and numbness of the lower limbs. Low-grade glioma of the spinal cord was suspected. MRI of the spinal cord had repeatedly been interpreted as myelitis. A finding of pleocytosis in the cerebrospinal fluid supported the hypothesis of inflammatory aetiology. Atypical cells with malignant characteristics were found in the cerebrospinal fluid. Antibiotics, antiviral drugs and corticosteroids were administrated. Nevertheless, clinical and MRI findings progressively deteriorated. Because intradural haematoma was suspected, surgical decompression was performed five days after admission. Histological examination of the removed tissue corresponded to anaplastic astrocytoma converted into glioblastoma. Over the next few days, the patient developed respiratory insufficiency requiring artificial lung ventilation. The patient died of septic shock resulting from ventilator-associated pneumonia two days after the diagnosis, the 11^th day of hospitalization. Autopsy confirmed glioma that, however, was localized in the caudal part of the spinal cord only. Only secondary changes –⁠ oedema and segmental haemorrhage –⁠ occurred in the remaining part of the spinal cord up to the medulla oblongata. There was no confirmed meningeal infiltration despite the presence of tumour cells in the cerebrospinal fluid.

Key words:
spinal cord high-grade glioma –⁠ myelitis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Accepted for review:
10. 5. 2012

Accepted for publication:
2. 8. 2012

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