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Table of Contents    
NEUROIMAGES
Year : 2018  |  Volume : 66  |  Issue : 3  |  Page : 886-888

An unusual cause of combined cauda equina and conus medullaris syndrome


Department of Spine Surgery, VPS Lakeshore Hospital, Ernakulam, Kerala, India

Date of Web Publication15-May-2018

Correspondence Address:
Dr. Suraj Sajeev
VPS Lakeshore Hospital, Ernakulam - 682 040, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.232280

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How to cite this article:
Sajeev S, Krishnakumar R. An unusual cause of combined cauda equina and conus medullaris syndrome. Neurol India 2018;66:886-8

How to cite this URL:
Sajeev S, Krishnakumar R. An unusual cause of combined cauda equina and conus medullaris syndrome. Neurol India [serial online] 2018 [cited 2018 Aug 17];66:886-8. Available from: http://www.neurologyindia.com/text.asp?2018/66/3/886/232280




A 38-year old lady developed insidious onset of asymmetric weakness of both lower limbs, sphincteric paralysis and saddle anesthesia. Magnetic resonance imaging [Figure 1], [Figure 2], [Figure 3] with contrast revealed a lobulated intramedullary lesion from D11 to L1 levels involving the conus medullaris with no metastases in the brain.
Figure 1: T2 sagittal image showing a 5.6 × 1.5 cm intramedullary lesion involving the conus medullaris region, extending to the filum terminale with a prominent syrinx (arrow) proximal to the tumor

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Figure 2: T2 axial image showing expansion of the cord with tumor (arrow) abutting the dura

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Figure 3: T1 sagittal image with contrast showing the heterogeneous enhancement of the tumor (arrow)

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The tumor was excised with a T11-L1 laminectomy under neuromonitoring guidance. Intraoperatively, the lesion was found to infiltrate the cauda equina roots [Figure 4] and [Figure 5]. Histopathology revealed glioblastoma WHO grade IV [Figure 6], [Figure 7], [Figure 8]. Immunohistochemical study revealed cells strongly positive for glial fibrillary acid protein (GFAP), S-100 with a high Ki-67 proliferation index. Cluster of differentiation (CD) 34 was negative.[1],[2],[3] The patient did not develop further neurological deficit and received concurrent chemoradiation with temozolamide and 50 Gy radiation in 25 fractions over 5 weeks.[4]
Figure 4: Photomicrograph (hematoxylin and eosin ×200 magnification) of the glioblastoma showing a brisk mitotic activity (black arrows), pleomorphism, and hyperchromatism

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Figure 5: Photomicrograph (hematoxylin and eosin ×100 magnification) of the glioblastoma showing palisading necrosis (black box) and bizarre multinucleated tumor giant cells (black arrow)

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Figure 6: Immunohistochemistry study (×100 magnification) showing diffuse strong positivity to GFAP (glial fibrillary acidic protein)

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Figure 7: Immunohistochemistry study (×100 magnification) showing diffuse strong positivity to S-100

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Figure 8: Immunohistochemistry study (×100 magnification) for Ki-67 showing a high proliferation index

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

Informed consent was obtained from the patient and there were no conflicts of interest.



 
  References Top

1.
Morais N, Mascarenhas L, Soares-Fernandes JP, Silva A, Magalhães Z, Costa JA. Primary spinal glioblastoma: A case report and review of the literature. Oncol Lett 2013;5:992-6.  Back to cited text no. 1
    
2.
Singh PK, Singh VK, Tomar J, Azam A, Gupta S, Kumar S. Spinal glioblastoma multiforme: Unusual cause of post-traumatic tetraparesis. J Spinal Cord Med 2009;32:583-6.  Back to cited text no. 2
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3.
Prasad GL, Borkar SA, Subbarao KC, Suri V, Mahapatra AK. Primary spinal cord glioblastoma multiforme: A report of two cases. Neurol India 2012;60:333-5.  Back to cited text no. 3
  [Full text]  
4.
Mallick S, Madan R, Julka PK. Primary spinal glioblastoma treated with adjuvant radiation and temozolomide: Report of two cases. J Can Res Ther 2015;11:654.  Back to cited text no. 4
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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