Submit manuscript...
Journal of
eISSN: 2373-6410

Neurology & Stroke

Commentary Volume 8 Issue 1

Commentary: A Huge Ependymoma of the Cervical Spinal Cord with Subtle Atypical Manifestations and Hyperhidrosis

Kaveh Haddadi

Department of neurosurgery, Mazandaran University of Medical Science, Iran

Correspondence: Kaveh Haddadi, Associate professor, department of neurosurgery, spine fellowship scholar of Boston University Medical Center, orthopedic Research Center, Mazandaran University of Medical Science, and Sari, Iran

Received: November 19, 2017 | Published: January 8, 2018

Citation: Haddadi K (2018) Commentary: A Huge Ependymoma of the Cervical Spinal Cord with Subtle Atypical Manifestations and Hyperhidrosis. J Neurol Stroke 8(1): 00272. DOI: 10.15406/jnsk.2018.08.00272

Download PDF

Background

Usually, tumors of the cervical spine can be separated into two groups: those that originate in the bone, and those that start inside the spinal canal and comprise the spinal cord and nerves. It is frequently problematic to state from the patient’s history only wherever the tumor is rising from, as neck pain is typically the primary complaint in both categories of tumors.

Tumors inside the spinal canal commonly happen either in the spinal cord, a peripheral nerve, or the cover round the spinal cord. Tumors that arise from the neural components are too infrequent. Tumors that origin from the spinal cord account for five percent of all spinal tumors. The most common tumors rising from the spinal cord are astrocytoma’s, ependymomas, and hemangioblastomas. Though frequently are benign, but they be able to be challenging to eliminate because of their position in the spinal canal.

The most public initial symptom in patients with cervical spine tumors is neck pain. The pain might start progressively and develop more prominent over a prolonged period of time. Patients may also have shoulder, arm, or leg pain as the tumor mass extends beyond the confines of the bone or spinal canal to involve the spinal cord or nerve roots. As the tumor remains to grow, numbness, tingling, in the arms or legs might be observed. Through additional growth, weakness in the arms or legs can progress, as well as a reduced capability to normal walk. There can even be with bladder and bowel function problems.

Ependymomas

Ependymomas are the most public spinal cord neuro-epithelial tumors, comprising for about 60 percent of spinal cord gliomas.1 adults ependymomas describe the most shared intramedullary tumors of spinal cord. Nearly 2/3 of spinal cord ependymomas include cervical levels.2 Accountable on location, the spinal cord tumors present by varied symptoms, as well as neck or back pain and motor signs and sensory symptoms.3,4 The non-specific clinical manifestation of a spinal cord tumor frequently consequences in delay of diagnosis by disparate outcomes.

Traditional spinal ependymomas mostly interrupt middle-aged adults with the same sex spreading. While the cervical cord denotes only 22.5 percent of spinal cord tissue, up to 68 percent of tumors rise from or extent into the cervical cord.5

Manifestations

Intra medullary ependymoma of spinal cord be able to occur through a multiplicity of symptoms. Neck or back pain is regularly the initial symptom.6,7 Sensory symptoms commonly ante date the motor symptoms and are reliable with the central position of the lesion inside the spinal cord.

Hyperhidrosis

Hyperhidrosis is an unusual symptom of intramedullary spinal cord tumors; there are only fore cases of hyperhidrosis produced by this category of tumor in the writings. The histo-pathological investigation in these cases was astrocytoma in two8 and gangliocytoma in one of them9 and the last one was ependymoma.10 Participation of the descendant autonomic paths, which are situated among the corticospinal and spinothalamic tracts, could reason both sympathetic and parasympathetic disorders below the level of the lesion. Hyperhidrosis has been defined in patients with spinal cord injured11-13 and similarly in post-traumatic syringomyelia.12-14 To be expected there is an involvement of the sympathetic fibers in the upper cervical cord or in the ciliospinal center of Budge at the C8-T2 segmental level. Hyperhidrosis in this example might be presumed to have happened by means of over activity of the sympathetic fibers owing to irritation by the tumor. It can be imagined that had no management been done, the hyperhidrosis may have increasingly advanced to anhydrases.

Conclusion

Cervical intramedullary ependymoma is an infrequent, slow growing spinal cord tumor. Consideration to surprising features like hyperhidrosis might be a vital fundamental to quick diagnosis of this rare spinal tumor. Early recognition of the tumor is important for best postoperative functional grade.

Acknowledgments

None.

Conflicts of interest

None.

References

  1. Cooper PR (1989) Outcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long-term results in 51 patients. Neurosurgery 25(6): 855-859.
  2. Ferrante L, Mastronardi L, Celli P, Lunardi P, Acqui M, et al. (1992) Intramedullary spinal cord ependymomas-a study of 45 cases with long-term follow-up. Acta Neurochir 119(1-4): 74-79.
  3. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, et al. (2007) The 2007 WHO classification of tumors of the central nervous system. Acta Neuropathol 114(2): 97-109.
  4. J Cho JC, Miller A, Kettner NW (2009) Cervical ependymoma in a male adolescent with neck and back pain. J Manipulative Physiol Ther 32(8): 695-700.
  5. Alkhani A, Blooshi M, Hassounah M (2008) Outcome of surgery for intramedullary spinal ependymoma. Ann Saudi Med 28(2): 109-113.
  6. Bostrom A, von Lehe M, Hartmann W, Pietsch T, Feuss M, et al. (2011) Surgery for spinal cord ependymomas: outcome and prognostic factors. Neurosurgery 68(2): 302-308.
  7. Quinones-Hinojosa A, Gulati M, Lyon R, Gupta N, Yingling C (2002) Spinal cord mapping as an adjunct for resection of intramedullary tumors: surgical technique with case illustrations. Neurosurgery 51(5): 1199-1206.
  8. Jacob JT, Cohen-Gadol AA, Scheithauer BW, Krauss WE (2005) Intramedullary spinal cord gangliocytoma: case report and a review of the literature. Neurosurg Rev 28(4): 326-329.
  9. Kilinçer C, Oztürk L, Hamamcioglu MK, Altunrende E, Cobanoglu S (2007) An upper thoracic spinal cord tumor presenting as hemifacial hyperhidrosis. Surg Neurol 68(4): 461-463.
  10. Kaveh Haddadi (2016) A huge ependymoma of the cervical spinal cord with subtle atypical
    manifestations and hyperhidrosis: Case report. Int J Surg Case Rep 19: 100-102.
  11. E Holzle (1983) Physio pathologic aspects and clinical pictures in hyperhidrosis (Article in German). Hautartz 34(12): 596-604.
  12. Hai Le, Rishi Wadhwa, Susan Le, Cotter J, Han Lee, et al. (2014) Cervical Spine Ependymoma with Hematomyelia: Case Report and Review of the Literature. J Spine 3: 3.
  13. Ahmad Ghasemi, Kaveh Haddadi, Ali Ahmadi Shad (2015) Comparison of Diagnostic Accuracy of MRI with and Without Contrast in Diagnosis of Traumatic Spinal Cord Injuries. Medicine 94(43): e1942.
  14. Haddadi k (2016) Outlines and Outcomes of Instrumented Posterior Fusion in the Pediatric Cervical Spine: A Review Article. J Pediatr Rev 4(1): e4765.
Creative Commons Attribution License

©2018 Haddadi. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.