Introduction: Intradural spinal cord tumors are uncommon with an incidence of 3 per 100,000 individuals. Multiple reports concerning intraspinal hematomas with neurologic deterioration following spinal needle insertion exist, but few reports have confirmed intraspinal hemorrhages from an undiagnosed lumbar ependymoma after attempted spinal anesthesia.
Methods: A 22-year-old male with progressive low back pain presented with sensory and motor deficits of both lower extremities after incurring unsuccessful lumbar punctures for a urologic procedure under spinal anesthesia. A contrastenhanced multiplanar MRI demonstrated a large, nodular intradural mass from L2 to S2. Posterior decompression, intradural tumor resection, and posterior instrumentation with spinal fusion from L2 to L5 were carried out.
Results: Histomorphologic study of the tumor specimen showed myxopapillary ependymoma (WHO Grade 1). Hip flexors and knee extensors improved to 4/5 bilaterally by the 2nd week after surgery, the ankle dorsiflexors and big toe extensors to 4/5 bilaterally by the 3rd week and the ankle plantarflexors to 4/5 bilaterally by the 4th week. Patient was already ambulating with walker assistance a month after surgery. Ankle clonus disappeared by the 2nd week, and both dermatomal and peri-anal sensations were fully regained bilaterally by the 4th week.
Conclusion: Intradural myxopapillary ependymoma is thought to be prone to hemorrhage due to its vascular structure. This report draws attention to the need for careful evaluation of symptoms suggesting the presence of a spinal mass, before lumbar puncture, peridural, or spinal anesthesia is planned.
Rosario MS and Sison JKT
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