• The Korean Journal of Pain
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• 제18권1호
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• pp.69-73
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• 2005

This report describes a case of spinal nerve root compression due to an acute inflammatory granuloma after lumbar surgery. A 39 year-old man with a history of increasing back pain with a 3-week duration was diagnosed with a herniated intervertebral disc (HIVD). The diagnosis of a HIVD was confirmed by magnetic resonance imaging (MRI) with indications for surgery. A discectomy and a partial laminectomy was performed and the symptoms were alleviated immediately after surgery for a five-day period. However, a slowly progressing pain was subsequently noted along a different dermatome. There was no pain relief despite the patient being given pharmacological treatments, combined with an epidural steroid injection. The follow up MRI images showed severe compression of the nerve roots by a epidural lesion. Another procedure was performed 17 days after the initial operation. The lesion responsible for the compression of the nerve roots was found to be an acute inflammatory granuloma. The pain was relieved after the second procedure and there were no other symptoms or neurological problems. This case is remarkable in that a granuloma formed relatively quickly and grew to such a size that it was able to severely compress the surrounding nerve roots.

• Journal of Korean Neurosurgical Society
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• 제29권7호
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• pp.891-898
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• 2000

Objective : It is difficult to differentiate intramedullary spinal cord tumors preoperatively from non-neoplastic pathologies in patients presenting as non-compressive myelopathies in magnetic resonance imaging(MRI). In this report, the authors reviewed nonneoplastic intramedullary spinal cord lesions preoperatively diagnosed as tumors and discussed their clinical and radiological characteristics and usefulness of surgical intervention. Methods : From January, 1985 to January, 1999, authors experienced eight non-neoplastic pathologies mimicking intramedullary spinal cord tumors and analysed their medical records, radiological findings and histopathological specimens retrospectively. Results : There were five males and three females and the duration of symptoms were from two to 20 months(mean, 9.8 months). The location of lesions were four cervical, one cervicothoracic and three thoracic. All patients manifested sensory abnormality, seven motor weakness, and six bladder symptom. All cases had swollen spinal cords and increased signal intensities in spin-echo sequences. Six cases showed contrast enhancement : four cases were focal and two diffuse. Under the impression of intramedullary tumors, the patients were operated upon. Final diagnoses on the base of clinical and pathologic finding were : three subacute necrotizing myelopathies, two multiple scleroses, two myelopathy of unknown etiology. One case showed no gross abnormality in surgical field in spite of adequate exposure of the lesion, so biopsy was not performed. In that case, postoperative MRI revealed spontaneous resolution of the lesion. Conclusion : MRI is invaluable diagnostic tool in screening myelopathies. However, its high sensitivity and lack of specificity make difficulty in preoperative differential diagnosis of non-compressive myelopathies. Although no surgical morbidity occurred in our series, we sometimes failed to confirm definite diagnosis even with biopsy. In such a circumstance, long-term follow up is needed.

• The Korean Journal of Pain
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• 제23권1호
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• pp.51-54
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• 2010

A herniated intervertebral disc is the most common type of soft tissue mass lesion within the lumbar spinal canal. Magnetic resonance imaging (MRI) is a useful tool for the assessment of patients with lower back pain and radiating pain, especially intervertebral disc herniation. MRI findings of intervertebral disc herniation are typical. However, from time to time, despite an apparently classic history and typical MRI findings suggestive of disc herniation, surgical exploration fails to reveal any lesion of an intervertebral disc. Our patient underwent lumbar disc surgery with the preoperative diagnosis of lumbar disc herniation; however, nothing could be found during the surgical procedure, except a swollen nerve root.

• Journal of Korean Neurosurgical Society
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• 제53권5호
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• pp.316-319
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• 2013

Neuromyelitis optica (NMO) is considered to be a rarer autoimmune disease than multiple sclerosis. It is very difficult to make a diagnosis of MNO for doctors who are not familiar with its clinical features and diagnostic criteria. We report a case of a young female patient who had been suffering motor weakness and radiating pain in both upper extremities. Cervical MRI showed tumorous lesion in spinal cord and performed surgery to remove lesion. We could not find a tumor mass in operation field and final diagnosis was NMO. NMO must be included in the differential diagnosis of lesions to rescue the patient from invasive surgical interventions. More specific diagnostic tools may be necessary for early diagnosis and proper treatment.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.395-399
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• 2001

척추 경막외 임파종은 전체 임파종의 7%정도를 차지하며, 가장 흔한 증상으로 척수 압박 증세를 유발하는 것으로 알려져 있다. 그 중에서도 원발성 척추 경막외 임파종, 즉 다른 장기의 침범 소견 없이 척추에만 국한되어 나타난 임파종은, 당뇨병 환자에서 급성 척수 압박 증상으로 나타났을 때, 척추 경막외 농양과의 감별을 요한다. 저자들은 48세의 여자 당뇨 환자에서 흉추부의 통증으로 내원 1개월 전까지 여러 차례 침술치료를 받고 난 후 통증이 악화되고 급성 하반신 부전마비와 배뇨 장애 및 감염 징후가 있어 본원에 내원하여, 병력과 제반 검사상 수술전에 척추 경막외 농양으로 진단되었던 원발성 척추 경막외 임파종 1례를 수술 치험하고 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제50권1호
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• pp.60-63
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• 2011

Seizure is a foreseeable risk in patients with brain lesion. However, seizure during treating non-brain lesion is not a familiar situation to neurosurgeon. Posterior reversible encephalopathy syndrome (PRES) is a relatively common situation after systemic chemotherapy. The aim of this study is to make neurosurgeons aware of this potential medical problem. A 52-year-old woman with advanced gastric cancer, presented with low back pain due to spinal metastasis at the 4th lumbar vertebra. Ten cycles of chemotherapy with FOLFOX (5-Fluoruracil/Oxaliplatin) had been completed 23 days ago. Two days before the planned operation, a generalized tonic clonic seizure occurred. She did not have a history of hypertension or seizure. The seizure was stopped with lorazepam 4mg. The brain magnetic resonance (MR) imaging showed high signal changes in both parieto-occipital lobes on the T2-weighted images, and these were partially enhanced, suggesting PRES. The surgery was preceded by treatment with an antiepileptic drug. The MR images, taken 1.5 months after the seizure, showed that the lesion was no longer present. At 3 month follow-up, no additional seizure attack occurred without any seizure medication. The possibility of a seizure attack should be considered if the patient has a history of chemotherapy.

• Journal of Korean Neurosurgical Society
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• 제45권4호
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• pp.256-259
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• 2009

The authors report a case of 42-year-old woman with an intraventricular tumor in the trigone of the left lateral ventricle. The first operation achieved a microscopically complete resection. The tumor was histologically atypical meningioma. After 26 months, there were recurrences of intraventricular meningioma. Complete resection of the tumor and adjuvant radiation therapy were performed, and the histological diagnosis was malignant meningioma. Sixteen months after the second operation, spinal metastasis in cervicolumbar lesion was diagnosed and a subtotal removal of cervical intradural extramedullary mass was performed. We describe an unusual case of intraventricular malignant meningioma with cerebrospinal fluid-disseminated spinal metastases with review of the clinical courses of previous reports.

• Journal of Korean Neurosurgical Society
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• 제44권2호
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• pp.84-87
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• 2008

Spontaneous spinal epidural hematoma (SSEH) is rare in children. especially in infants, in whom only 12 cases have been reported. Because of the nonspecificity of presenting symptoms in children, the diagnosis may be delayed. We report herein a case of SSEH in a 20-month-old girl who initially presented with neck pain, and developed lower extremity motor weakness and symptoms of neurogenic bladder 2 weeks prior to admission. The magnetic resonance imaging showed an epidural mass lesion extending from C7 to T4, and the spinal cord was severely compressed by the mass. After emergency decompressive surgery the neurologic function was improved immediately. Two months after surgery, the neurological status was normal with achievement of spontaneous voiding. We suggest that surgical intervention can provide excellent prognosis in case of SSEH in infants, even if surgery delayed.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.836-840
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• 2000

Intramedullary spinal hemagioblastomas usually develope in cervical or thoracic region of spinal cord, but rarely in conus medullaris. We report a case of hemangioblastoma developed in conus medullaris. The 19-year-old male patient presented with slowly progressing low back pain and paresthesia of both legs. MRI and spinal angiography revealed a well-vascularized mass lesion in the conus medullaris with syrinx formation. Total excision of hemangioblastoma was achieved via posterior approach. Postoperatively, patient's walking difficulty was worsened transiently, but it was improved at discharge.

• Journal of Korean Neurosurgical Society
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• 제48권6호
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• pp.547-550
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• 2010

Spinal cysticercosis is a very uncommon manifestation of neurocysticercosis which is caused by the larvae of Taenia solium. However, it can develop as a primary infection through blood stream or direct larval migration. It can result in high recurrence and severe neurologic morbidity if not treated appropriately. We report the case of a 43-year-old woman who presented with severe lower back pain and left leg radiating pain in recent 2 weeks. Magnetic resonance image (MRI) of lumbar spine demonstrated extruded disc at the L5-S1 level combined with intradural extramedullary cystic lesion. We performed the open lumbar microdiscectomy (OLM) at L5-S1 on the left with total excision of cystic mass. After surgery, the patient showed an improvement of previous symptoms. Diagnosis was confirmed by histopathological examination as intradural extramedullary cysticercosis. We discuss clinical features, diagnostic screening, and treatment options of spinal cysticercosis.