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

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‘ workplace: 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: Cesk Slov Neurol N 2013; 76/109(1): 104-109
Category: Case Report


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 11th 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


1. Rodrigues GB, Waldron JN, Wong CS, Laperriere NJ. A retrospective analysis of 52 cases of spinal cord glio­­ma managed with radiation therapy. Int J Radiat Oncol Biol Phys 2000; 48(3): 837–842.

2. Choi WC, Lee JH, Lee SH. Spinal cord glioblastoma multiforme of conus medullaris masquerading as high lumbar disk herniation. Surg Neurol 2009; 71(2): 234–237.

3. Lawson-Smith M, Samandouras G, Hinks T, Tan PL, Quaghebeur G, Mathews P et al. Spinal cord infarction caused by malignant intramedullary glioma: the traps of epidemiology and travel history. Br J Neurosurg 2004; 18(2): 199–200.

4. Milano MT, Johnson MD, Sul J, Mohile NA, Korones DN, Okunieff P et al. Primary spinal cord glioma: a Surveillance, Epidemiology, and End Results database study. J Neurooncol 2010; 98(1): 83–92.

5. Banczerowski P, Simó M, Sipos L, Slowik F, Benoist G, Veres R. Primary intramedullary glioblastoma multiforme of the spinal cord: report of eight cases. Ideggyogy Sz 2003; 56(1–2): 28–32.

6. Struhal W, Oberndorfer S, Lahrmann H, Lindeck--Pozza E, Hess B, Nussgruber V et al. Myeloid sarcoma in the central nervous system: case report and review of the literature. Acta Clin Croat 2008; 47(1): 19–24.

7. Meligonis G, Sur M, Ouma J, Grayson W, Farrell VJ. Gliomatosis of the brain and spinal cord masquerading as infective lesions. Surg Neurol 2002; 57(6): 399–404.

8. D’Haene N, Coen N, Neugroschl C, Balériaux D, Salmon I. Leptomeningeal dissemination of low-grade intramedullary gliomas: about one case and review. Clin Neurol Neurosurg 2009; 111(4): 390–394.

9. Saad A, Tuli S, Ali EN, Houtchens M, Delalle I, Kesari S. Pilocytic astrocytoma of the spinal cord in an adult. J Neurooncol 2008; 88(2): 189–191.

10. Yaguchi M, Nakasone A, Sohmiya M, Saitoh F, Ohya N, Yoshida T et al. Gliomatosis cerebri involving the lumbosacral spinal cord. Intern Med 2003; 42(7): 615–618.

11. Porter A, Lyons MK, Wingerchuk DM, Bosch EP. Spinal cord astrocytoma presenting as “idiopathic” intracranial hypertension. Clin Neurol Neurosurg 2006; 108(8): 787–789.

12. Riva M, Bacigaluppi S, Galli C, Citterio A, Collice M. Primary leptomeningeal gliomatosis: case report and review of the literature. Neurol Sci 2005; 26(2): 129–134.

13. Ko MW, Turkeltaub PE, Lee EB, Gonatas NK, Volpe NJ, Moster ML et al. Primary diffuse leptomeningeal gliomatosis mimicking a chronic inflammatory meningitis. J Neurol Sci 2009; 278(1–2): 127–131.

14. Schmidbauer M, Müller C, Podreka I, Mamoli B, Sluga E, Deecke L. Diffuse cerebrospinal gliomatosis presenting as motor neuron disease for two years. J Neurol Neurosurg Psychiatry 1989; 52(2): 275–278.

15. Vassilyadi M, Michaud J. Hydrocephalus as the initial presentation of a spinal cord astrocytoma asso­ciated with leptomeningeal spread. Pediatr Neurosurg 2005; 41(1): 29–34.

16. Knox MK, Ménard C, Mason WP. Leptomeningeal gliomatosis as the initial presentation of gliomatosis cerebri. J Neurooncol 2010; 100(1): 145–149.

17. Perilongo G, Gardiman M, Bisaglia L, Rigobello L, Calderone M, Battistella A et al. Spinal low-grade neoplasms with extensive leptomeningeal dissemination in children. Childs Nerv Syst 2002; 18(9–10): 505–512.

18. Henning A, Schär M, Kollias SS, Boesiger P, Dydak U. Quantitative magnetic resonance spectroscopy in the entire human cervical spinal cord and beyond at 3T. Magn Reson Med 2008; 59(6): 1250–1258.

19. Cohen-Gadol AA, Zikel OM, Miller GM, Aksamit AJ, Scheithauer BW, Krauss WE. Spinal cord biopsy: a review of 38 cases. Neurosurgery 2003; 52(4): 806–816.

Paediatric neurology Neurosurgery Neurology

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