Clinical presentation and surgical outcomes of an intramedullary C2 spinal cord cavernoma: a case report and review of the relevant literature

Abstract

Background: The spinal cord intramedullary cavernoma (SCIC) is a rare form of hemangioma that typically behaves as a space-occupying lesion resulting in neurological symptoms, including bladder and bowel dysfunction. To date, there have been few reports characterizing the clinical presentations and surgical outcomes of cavernomas at the C2 spinal level or the potential for resolution of bladder and bowel symptoms postoperatively. This case details the clinical course of a patient with a C2 cavernoma with an atypical neurological presentation and rapid improvement in both bladder and bowel function postoperatively. This case reviews the relevant literature and describes the patient's clinical presentation, radiological and pathological findings and post-surgical progress.

Methods: A 56-year-old male presented with sensory changes in his right hand, which rapidly progressed over ensuing weeks to bilateral sensory changes in the upper and lower limbs, gait imbalance, urinary and faecal incontinence and loss of temperature perception. He subsequently developed significant weakness in the upper limbs. A MRI identified a hematoma in the cervical cord at the C2 level. Given his rapid neurological decline and the social and clinical implications of his bladder and bowel instability, a surgical approach to therapy was adopted.

Results: Postoperatively, there was steady improvement in motor and sensory function and a complete return of bladder and bowel function.

Conclusions: Intramedullary spinal cord cavernomas, although rare, can cause significant neurological deficits and morbidity. Surgical excision can provide significant benefits, including restoration of bladder and bowel function.

Keywords: Bladder; bowel; cavernous malformation; hemangioma; intramedullary cavernoma; spinal cord tumour; vascular malformation.

Figure 1

Preoperative sagittal T1-weighted (A) and T2-weighted (B) Magnetic resonance imaging (MRI) showing a spinal cord intramedullary cavernoma at C2. Preoperative axial gradient echo (C) shows hemorrhagic products with a hemosiderin ring. Postoperative sagittal T1-weighted (D) and T2-weighted (E) MRI. Postoperative sagittal gradient echo (F) shows reduced blooming artefact with reduced mass effect and resolved spinal cord oedema.

Figure 2

Histopathology shows old and new hemorrhages with areas of thin walled blood vessels and gliosis. H&E stain, magnification ×40 (A) and ×100 (B).