Key Clinical Findings & Highlights
- Addresses emergency management of spinal tumor apoplexy and cord compression.
- Demonstrates total microsurgical resection from C2 to C5 cervical spine.
- Results in rapid post-operative motor recovery and complete ambulatory independence.
Abstract
Introduction & Background
While minor microscopic hemorrhage and thrombosis are occasionally identified histologically in schwannomas (Antoni B areas), acute macro-hemorrhage leading to apoplexy of a spinal nerve sheath tumor is an extraordinary rarity. Emergency surgical decompression is mandatory to reverse ischemic spinal cord injury.
Clinical Case Presentation & Diagnosis
A 46-year-old man with a mild prior neck ache presented with sudden severe cervical pain followed by rapid onset progressive weakness in all four extremities over 12 hours. Neurological assessment confirmed severe spastic quadriparesis (motor power 2/5 in upper limbs, 1/5 in lower limbs) and a distinct sensory level at C4. Emergency cervical spine MRI demonstrated a long-segment intradural extramedullary lesion from C2 to C5 with mixed T1/T2 signal intensity and fluid-fluid levels indicative of acute subacute hematoma.
Surgical Technique & Management
Emergency posterior cervical laminectomy from C2 to C5 was performed. Following midline dural opening, a dark red, tense, multiloculated hemorrhagic tumor was encountered severely compressing the spinal cord toward the right anterolateral canal. Under microscopic illumination, intratumoral clot evacuation and complete capsule resection with preservation of the rootlet bundles were accomplished.
Discussion & Literature Context
Hemorrhage in schwannomas is attributed to ectatic, thin-walled hyalinized blood vessels undergoing spontaneous rupture under hemodynamic stress. Immediate microsurgical evacuation within 24 hours of neurological deterioration prevents permanent myelopathic deficit.
Conclusion
High index of clinical suspicion and emergent surgical decompression are essential in resolving acute quadriparesis caused by hemorrhagic spinal schwannomas.
How to Cite This Research
P. R. Singh, N. Nayak, Dr. Surendra K. Gupta, R. K. Sharma, A. Shukla, L. S. Nehete (2020). "Hemorrhage in long segment cervical schwannoma: case report and literature review". Surgical Neurology International, Volume 11, Article 476, Page 1.
