Case 247 -- Progressive Tetraparesis

Contributed by José Eymard H. Pittella M.D. 1, Cristiane C. da Costa M.D. 1, Alexandre V. Giannetti M.D. 2 and Francisco Otaviano L. Perpétuo M.D. 2
1 Laboratory of Neuropathology, Department of Pathology and Forensic Medicine, 2 Department of Neurosurgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
Published on line in October 2000


A 47-year-old male patient with a six-month progressive tetraparesis and sphincter disturbances was admitted at the hospital. The neurological examination showed spastic tetraparesis and hypoestesis below T6. A myelotomography followed by a cervical CT scan was in favor of an extradural lesion, posterior to the C5 vertebral body. The CSF examination disclosed lymphocytic pleocitosis and an increased protein content. An anterior corpectomy and diskectomy with interbody fusion from C4 to C6 was performed. No extradural lesion was found. An anterior ligament biopsy was normal. The patient presented discreet and temporary improvement. Two years after surgery, the patient was readmitted with a tetraplegia at the C5 level. A cervical MRI study revealed an ill-defined, enhancing lesion from C1 to C6, attached to the anterior and lateral face of the thickened dura mater and compressing the spinal cord (Figs. 01 and 02). The patient died some months later from septicemia. As consented to by the patient's family, the necropsy was limited to the spinal cord examination.





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