Abstract
Objective: n/a
Background: Cavernous Malformations (CM) are abnormal collections of tiny dilated vessels that can occur in the brain or spinal cord. If hemorrhage of a CM occurs in the spinal cord it can present as an acute non-inflammatory myelopathy. This is distinct from Transverse Myelitis (TM), which is an inflammatory myelopathy that presents with autonomic dysfunction, weakness and a sensory level.
Design/Methods: n/a
Results: We report the case of a 27-year-old man who presented with acute onset urinary retention, bilateral lower extremity weakness and sensory alteration. MRI of the thoracic spine showed diffuse abnormal signal within the central cord from T2 to T12 with cord expansion and enhancement at T8. He underwent multiple MRIs and angiograms without a structural cause identified. Given the cord swelling, TM was suspected, however serum and CSF studies were unremarkable. He was treated with high dose steroids and plasmapheresis without improvement of his condition. His symptoms progressed to paraplegia. Eleven weeks from presentation he underwent spinal surgery and was found to have a ruptured intramedullary CM at T8. The CM was resected and after a year of intensive physical therapy the patient regained the ability to walk independently and had continued improvement.
Conclusions: This case highlights the need to suspect CM as a cause of acute myelopathy when the etiology is elusive and the need for early neurosurgery involvement. Also of interest is the extensive central spinal cord lesion and edema which acutely appeared to mimic a longitudinally extensive transverse myelitis.
Disclosure: Dr. Nunes has nothing to disclose. Dr. Imran has nothing to disclose. Dr. Janarious has nothing to disclose. Dr. Ullah has nothing to disclose.
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