Spinal cord ependymoma presenting as acute paraplegia and subarachnoid hemorrhage: a case report and review of literature

Acute paraplegia is a rare presentation for a spinal cord ependymoma. Subarachnoid hemorrhage (SAH) due to spinal ependymoma is also very rare. We report a 32-year-old woman who presented with acute paraplegia and typical clinical signs of SAH with normal cerebral angiography, and further diagnostic work-up revealed an spinal cord ependymoma as the source of the hemorrhage. There is evidence that some spinal cord ependymomas have intratumoral hemorrhage, but most of these bleedings occur without symptoms. We discuss the clinical and neuroradiological findings of this rare case and review the literature related to this unusual presentation. Neurology Asia 2013; 18(4) : 431 – 434 Address Correspondence to: Wenshi Wei, Neurology department of Huadong Hospital, Fudan University, Shanghai, China, e-mail: [email protected] INTRODUCTION Acute paraplegia is a rare presentation for a spinal cord ependymoma. There is evidence both from surgery and magnetic resonance imaging (MRI) that some of the spinal ependymoma have intratumoral bleeding. However, most of these bleedings occur without symptoms. Based on Pubmed, there were only two cases of the spinal cord ependymoma presenting with acute paraplegia due to intratumoral and subarachnoid hemorrhage being reported since 1990. In the series by McCormick et al., of the 23 patients with ependymoma of the filum terminale, only two suffered acute neurological deterioration. In these two cases, MRI was not performed and intratumoral hemorrhage was confirmed at surgery. Subarachnoid haemorrhage (SAH) due to spinal ependymoma is also very rare. A review of the literature based on Pubmed showed that only 17 patients with spontaneous SAH due to a spinal ependymoma had been reported since 1958. We describe here a case of spontaneous intratumoral bleeding from a spinal ependymoma presented with acute paraplegia and SAH with normal cerebral angiography.