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Images in Neurology |

Thoracic Epidural Cavernous Hemangioma Imaging and Pathology

Sheetal Shivaprasad, MBBS1; Girish Shroff, MD2; Gerald A. Campbell, MD, PhD3
[+] Author Affiliations
1Department of Neurology, University of Texas Medical Branch at Galveston, Galveston, Texas
2Department of Radiology, University of Texas, Houston, Texas
3Department of Pathology, University of Texas Medical Branch at Galveston, Galveston, Texas
JAMA Neurol. 2013;70(9):1196-1197. doi:10.1001/2013.jamaneurol.188.
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A 45-year-old male prison inmate presented with a 1.5-year history of back pain. He described progressive weakness and numbness in the lower extremities over the past 6 months. He deteriorated from walking unassisted to requiring a cane and now a walker. He could no longer climb stairs or stand from a squatting position without assistance. There was no bowel, bladder, or sexual disturbance. Neurological examination revealed a diffuse increase in tone in the lower extremities. Strength scores in the hip flexors, adductors, and abductors were 3 of 5 and knee flexors and extensors and foot dorsiflexors were 4− of 5. The left lower extremity was weaker than the right. Sensory examination revealed impaired light touch, pinprick, and temperature sensation below the level of T5 through T6 on the left. Patellar reflex was 3+ with crossed adductors bilaterally. He had a spastic gait with impaired knee flexion.

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Figure 1.
Magnetic Resonance Imaging of an Epidural Mass

Magnetic resonance imaging reveals an epidural mass (asterisks) spanning the T6 through T7 levels and causing severe compression of the spinal cord. The top row demonstrates sagittal images and the bottom row shows corresponding axial images. A-F, The mass is hyperintense on T2-weighted imaging (A and B), is isointense on T1-weighted imaging (C and D), and enhances homogeneously on contrast-enhanced fat-saturated T1-weighted imaging (E and F). In part F, note the extension into the left neural foramen (arrow). G and H, Postoperative T2-weighted images reveal relief of cord compression. There is mild residual cord edema at the T5 through T6 levels.

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Figure 2.
Histologic Analysis of Cavernous Hemangioma

A, Low-magnification photomicrograph showing back-to-back thin-walled blood-filled vascular spaces within the lesion (hematoxylin-eosin, original magnification ×44). B, Higher magnification showing flat endothelial lining of vascular spaces and small foci of adipocytes within the irregular fibrous intervascular septae (arrow) (hematoxylin-eosin, original magnification ×110).

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