Spinal glioblastoma multiforme: unusual cause of post-traumatic tetraparesis

Abstract

Background/objective: Glioblastoma multiforme (GBM) is the most common glial cell tumor of the adult brain. However, primary GBM of the spinal cord is a rare condition.

Methods: Case report.

Results: A young man presented with acute onset quadriparesis after a whiplash injury. A magnetic resonance scan showed the typical appearance of a high-grade intramedullary tumor with fusiform expansion of the entire cervical cord. Subtotal decompression and biopsy was done by posterior laminectomy, followed by external beam radiotherapy. Signs and symptoms improved after the completion of radiotherapy but did not resolve completely. Death caused by respiratory failure occurred 3 months later.

Conclusions: This presentation of GBM of the cervical cord is rare; an intramedullary tumor should be considered when minor cervical trauma results in disproportionate neurologic deficit. To the best of our knowledge, this is the first reported case of spinal GBM with extensive pan-cervical involvement.

Figure 1. (a) T1-weighted image showing an iso- to hypointense mass in the cervical cord. (b) Lesion is better demarcated in the T2-weighted sequence showing enhancement on gadolinium injection. Tumor extends from the cervico-medullary junction to the first thoracic vertebra with fusiform expansion of the cervical cord. (c) Postcontrast T1-weighted coronal image at the level of the second cervical vertebra. An intrinsic tumor can be clearly visualized occupying most of the cervical cord with compression of normal parenchyma to the periphery and showing an inhomogeneous enhancement on contrast injection.

Figure 2. Intraoperative photograph showing expansion of cervical cord and overlying aberrant vessels.

Figure 3. Photomicrograph showing the typical findings of GBM: marked cellularity with hyperchromatism and pleomorphism (hematoxylin and eosin stains, 600 × 452).