Spinal cavernous haemangioma causing spastic paraparesis.

To cite: Valizadeh N, McCarthy P, Lynch JM. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013200679 DESCRIPTION A 66-year-old woman presented with a 9-month history of increasing difficulty in walking. Examination revealed asymmetric spastic paraparesis and a pyramidal pattern of weakness: Medical Research Council grade 4 on the left and 4+ on the right lower limb. Knee and ankle reflexes were symmetrical and pathologically brisk. Ankle proprioception was impaired and there was a suspended sensory level to pin-prick testing at T6/7. Examination was otherwise normal. MRI revealed an intensely enhancing bony and soft tissue lesion arising in the body and the neural arch of T7 (figure 1) with a large extradural soft tissue component significantly compressing the spinal cord (figure 2). The lesion was excised. A laminectomy was performed at T6 and T7, and the vertebrae from T4 to T8 were stabilised with a spinal rod. Histology of the mass confirmed a diagnosis of cavernous haemangioma. Vertebral haemangiomas are benign vascular tumours. They are present in up to 12% of the population at autopsy and represent 3% of all spinal tumours. Most are asymptomatic and are incidental findings on imaging. Only 0.9–1.2% cause symptoms. When presented, the symptoms typically involve vertebral pain or progressive neurological deficit. Surgical treatment is necessary in cases of cord compression. Our patient had an uneventful postoperative period. Three months postoperatively she had a significantly improved sensory and motor examination.