Published in:
01-12-2018 | Clinical Case
Freiburg Neuropathology Case Conference
Subacute Paraparesis in an Octogenarian
Published in: Clinical Neuroradiology | Issue 4/2018
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An 80-year-old male patient with a history of hairy cell leukemia (initial diagnosis 1992, complete remission 2017) was referred to the emergency department due to a proximal accentuated paraparesis that had occurred within the last 10 days. Throughout the last 8 weeks he complained about chest and back pain at the level of the thoracic spine. An initial therapy with nonsteroidal anti-inflammatory drugs and physiotherapy successfully relieved the pain. Within the last 10 days he experienced progressive gait disturbance with an ascending sensory dysfunction. At presentation the patient was only able to walk 5 m with the support of crutches. On admission the physical examination yielded a proximal grade 4 and distal grade 2 paraparesis according to the Medical Research Council (MRC) scale and a sensory level Th6 with accompanying ataxia. Magnetic resonance imaging (MRI) showed a space-occupying intraspinal, extradural lesion extending from Th3-6 (Figs. 1 and 2).
Fig. 1
Sagittal (a) and axial (b) T2-weighted images show an intraspinal, epidural space occupying lesion (a, b, arrow head) extending from thoracic level 3–6. The lesion displays homogeneous slightly elevated signal intensity when compared to the myelon and clearly dislocates the myelon. Axial images show infiltration of the transverse process, and paravertebral as well as subpleural extension of the tumor mass (b, arrow)
Fig. 2
Sagittal (a) and axial (b, c) T1-weighted images after i.v. administration of gadolinium show enhancement of the epidural portion of the tumor (a–c, arrow head). In addition, infiltration of the spinous process Th4 is clearly visible (a, arrow). Axial images show contrast enhancing portions of the tumor within the subpleural space (b, c, arrow head)
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