Congenital giant intramedullary spinal cord schwannoma.

A full-term infant with an uncomplicated vaginal delivery presented with absent cry on routine newborn heelstick testing. Neurologic examination revealed paraplegia, absent reflexes, and a T4 sensory level. Spinal MRI showed an expansive, gadolinium-enhancing intramedullary mass from T2 to the thecal sac (figure, A and B). Biopsy confirmed a diagnosis of cellular schwannoma, WHO grade 1 (figure, C). Genetic and immunohistochemical testing for NF-2 and schwannomatosis were negative. Cases of focal intramedullary schwannoma have been rarely reported.1,2 This congenital, extensive intramedullary schwannoma highlights the diversity of low-grade neonatal spinal neoplasms, obviating initiation of therapy until pathologic diagnosis is achieved.