Freiburg Neuropathology Case Conference
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CLINICAL CASE
Freiburg Neuropathology Case Conference Back Pain and Rapidly Progressing Gait Disorder in a 70-year-old Patient D. Erny1 · U. Taschner2 · J. Nakagawa3 · H. Urbach2 · M. Prinz1 · C. A. Taschner2 Published online: 26 August 2020 © The Author(s) 2020
Keywords Spinal metastasis · Chronic recurrent multifocal osteomyelitis · Spinal plasmocytoma · Spinal tuberculosis · Spinal lymphoma
Case Report A 70-year-old patient presented with back pain over the last 3 weeks that was initially controlled under analgesic medication. A weakness of both legs and exacerbation of the back pain resulted in hospitalization. On admission at a district hospital, the patient was still able to walk with the help of a walking frame. There was no known medical history of malignant diseases. Several years earlier the patient had suffered multiple left-sided embolic infarctions that resulted in a transient amaurosis and a discrete weakness of the right limb. Over the past few months, the patient had experienced an unintentional weight loss of 10 kg. After 3 days of hospitalization the patient suffered an acute deterioration of the neurological status and was transferred to our neurocenter. He now presented with a functional paraplegia of the left leg and high-grade paresis in the right leg associated with urinary retention. Sensory testing revealed impairment below Th5. Magnetic resonance imaging (MRI) of the thoracolumbar spine revealed multiple lesions of the vertebral bodies with an intraspinal mass
C. A. Taschner
[email protected] 1
Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
2
Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
3
Department of Neurosurgery, Medical Centre, University of Freiburg, Freiburg, Germany
lesion at level Th4/5 with subsequent spinal cord compression (Figs. 1, 2, 3 and 4). The patient underwent emergency surgery for spinal decompression at levels Th4/5. Therefore, a dorsal approach with left-sided hemilaminectomy of Th4 and 5 with undercutting to the contralateral side and flavectomy was performed. The epidural tumor was solid and of brown-greyish appearance and could be removed completely. In the recessed part, tumor growth continued into the vertebral body. Here, diffuse bleeding could be controlled and the lateral aspect of the spinal cord and the evolving nerve roots were decompressed bilaterally. At the end of surgery, the spinal cord was pulsating and there was no compression of the myelon at the exposed levels. The postoperative course was uneventful. The neurological status of the patient improved and the paraparesis regressed but he still could not stand nor walk without assistance.
Fig. 1 Sagittal reconstructions of computed tomography images of the thoracic spine in bone window setting showed increased density of large portions of the vertebral bodies of Th4 and Th5 (arrowheads). The vertebral body of Th5 showed a lytic area in its ventral portion and
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