PubMed · 6877554
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A Canady. 1983. Dural closure.. https://doi.org/10.1097/00006123-198306000-00022
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We report a case of spontaneous spinal epidural hematoma (SSEH) at the upper thoracic level which accompanied an epidural vascular lesion demonstrated by histological examination. A 62-year-old male was referred to our department, because of sudden onslaught of back pain, progressive paraparesis, and sensory disturbance below the dermatome of Th8. He had no history of a tendency to bleed, anticoagulant therapy, or trauma. There was no abnormality in the laboratory data. MRI revealed that an epidural mass at the level of dorsal T1 and T2 was compressing the spinal cord. Multilevel spondylotic change and thickened yellow ligament were also noted. Sixteen hours after the onset, we performed laminectomy at T1 and T2 and evacuated the epidural hematoma. An unusual vascular-net like tissue was found on the dura mater after removal of the hematoma. Postoperatively, neurological symptoms disappeared within three weeks. Histological appearance of the vascular tissue was a cluster of vessels containing a dilated vein with partially thin wall due to lack of elastic and collagen fibers. In reviewing the literature, there are several reports describing vascular lesions, such as cavernous angioma and AVM, as possible etiologies of SSEH. In the present case, long lasting compression of the posterior epidural venous plexus by the thick yellow ligament might have resulted in formation of an abnormal vein which ultimately caused bleeding.
We report a 60-year-old man who had a progressive neurologic deficit resulting from a Djindjian type 4 tentorial dural arteriovenous malformation (DAVM). The DAVM was repaired via percutaneous transvenous coil embolization.
An autopsy case of multiple myeloma (IgD lambda type) with pineal body and spinal cord dura mater infiltration is reported. The 63-year-old man was diagnosed as multiple myeloma (IgD lambda type). He was treated with melphalan and prednisolone. Extra bone marrow masses developed 1 year after the onset. He died with renal failure. At autopsy there were many extra bone marrow masses including pineal body and dura mater of the thoracic cord. Microscopic examination revealed that those mass lesions consisted of neoplastic plasma cells. Myeloma cells also infiltrated perivascular space near the pineal body, subdural space of the cerebrum and brain stem. The cells were labeled VS 38 c immunohistochemically. We discussed routes of the metastasis to the central nervous system of the multiple myeloma. This case suggests that the way of myeloma cells infiltration to the pineal body is hematogenous metastasis, because pineal body have no blood brain barrier.