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| 21KF-011 |
Spinal intramedullary cavernous angioma patient in pain clinic : A case report
Department of Anesthesiology and Pain Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea
Spinal intramedullary cavernous angioma is very rare spinal cord tumor and spontaneous bleeding is highly probable, bleeding causes rapid onset of general myelopathy symptoms. We report the case of a patient with spinal intramedullary cavernous angioma, who started with symptoms similar to those commonly seen in pain clinics, and early diagnosis and appropriate treatment have been hampered by the covid-19 vaccination history.
The patient was a 61-year-old Asian male, with prehypertension and a cerebral aneurysm. He visited the clinic due to paresthesia in the 3rd-4th intermetatarsal space, after first dose of mRNA covid-19 vaccine a day ago. Doctor performed foot ultrasonography, but it was normal. After 1weeks, pain in the right hip and numbness in the back of the thigh appeared, performed an MRI of the lumbar spine. but there were no specific findings. Under suspicion of pyriformis syndrome, prescribed medications and physical therapies. Four weeks after the first visit, the patient received a second dose of mRNA covid-19 vaccine, and admitted to the emergency room with numbness and paralysis in the entire right leg. Emergency medicine doctor suspected thrombosis caused by vaccination, and performed CT angiogram, but the findings were normal. So patient transferred to neurologist, patient had tingling under the T10 dermatome, weakness in the both lower extremities, and urinating symptom. The neurologist suspected acute transverse myelitis, a well-known vaccine side effect, and prescribed a whole spine MRI and start steroid pulse therapy. As a result of MRI, intramedullary cavernous angioma was seen in the T10 level spinal cord with signs of previous bleeding and was transferred to neurosurgery for surgical treatment.
Patient in this case showed the clinical features which can be mainly seen in pain clinics, but lesions were not found through imaging and physical examination performed at the pain clinic in general. And we found that in the case of spinal intramedullary cavernous angioma bleeding, the neurological symptoms progressed rapidly compared to other spinal cord tumors. Also, with covid-19 vaccination, resulting in wasting a lot of time and medical expenses for differential diagnosis of known vaccination side effects.
The patient was a 61-year-old Asian male, with prehypertension and a cerebral aneurysm. He visited the clinic due to paresthesia in the 3rd-4th intermetatarsal space, after first dose of mRNA covid-19 vaccine a day ago. Doctor performed foot ultrasonography, but it was normal. After 1weeks, pain in the right hip and numbness in the back of the thigh appeared, performed an MRI of the lumbar spine. but there were no specific findings. Under suspicion of pyriformis syndrome, prescribed medications and physical therapies. Four weeks after the first visit, the patient received a second dose of mRNA covid-19 vaccine, and admitted to the emergency room with numbness and paralysis in the entire right leg. Emergency medicine doctor suspected thrombosis caused by vaccination, and performed CT angiogram, but the findings were normal. So patient transferred to neurologist, patient had tingling under the T10 dermatome, weakness in the both lower extremities, and urinating symptom. The neurologist suspected acute transverse myelitis, a well-known vaccine side effect, and prescribed a whole spine MRI and start steroid pulse therapy. As a result of MRI, intramedullary cavernous angioma was seen in the T10 level spinal cord with signs of previous bleeding and was transferred to neurosurgery for surgical treatment.
Patient in this case showed the clinical features which can be mainly seen in pain clinics, but lesions were not found through imaging and physical examination performed at the pain clinic in general. And we found that in the case of spinal intramedullary cavernous angioma bleeding, the neurological symptoms progressed rapidly compared to other spinal cord tumors. Also, with covid-19 vaccination, resulting in wasting a lot of time and medical expenses for differential diagnosis of known vaccination side effects.
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