Contributed by G Stuart Rutherfoord, Deon Lamprecht and Richard H Hewlett
University of Stellenbosch, Neuroscience Unit, Tygerberg Hospital, Cape Town, South Africa
Published on line in September 2001
The patient is a 40 year old Xhosa male. His chief complaints are pain in the upper lumbar area and weakness of both lower limbs. The pain had been present for 7 months and the weakness for 4 months. Both pain and weakness had been getting progressively worse and for the last 3 months prior to admission he had to use crutches to walk. There was no complaint of urinary or rectal incontinence. There was a remote history of pulmonary tuberculosis for which he had taken a full course of therapy; he had no pulmonary complaints at presentation.
At examination he was emaciated and had enlarged lymph nodes in the groin and axilla. There was no splenomegaly. Local examination of the spine was normal with no tenderness present. Examination of the upper limbs was normal. Both lower limbs were severely atrophic and weak with power of 1/5 in extensor hallucis longus, 2/5 in ankle dorsi- and plantar flexion and 4/5 in knee and hip movements. The patient had increased tone and ankle reflexes as well as sustained clonus in the left ankle. Sensation to touch and pain was decreased below L3 bilaterally. Proprioception was intact. Sphincter tone was normal.
MR of the spine shows a sharply-circumscribed, oval-elongated mass in the dorsal epidural space deforming the dura and delineated by fat. The lesion is T1 homogeneous/isointense (Fig 1), T2 hyperintense and slightly inhomogeneous (Fig 2). T-1 with contrast shows it is strongly contrast enhancing (Fig 3).
Laminectomy of T10, T11 and T12 was performed. An extradural soft, vascular tumor was found dorsal to the cord. The mass was loosely applied to the dura and easy to remove.