Gliom vyššího stupně kaudální oblasti míchy imitující myelitidu – kazuistika

Title in English High-Grade Glioma of the Caudal Part of the Spinal Cord Mimicking Myelitis - a Case Report


Year of publication 2013
Type Article in Periodical
Magazine / Source Česká a slovenská neurologie a neurochirurgie
MU Faculty or unit

Faculty of Medicine

Field Neurology, neurosurgery, neurosciences
Keywords spinal cord high-grade glioma; myelitis
Description Spinal cord glioblastomas are very rare tumours constituting only about 1.5% of all primary spinal cord malignancies. This case report presents a 20-year-old man with high-grade glioma of the caudal part of the spinal cord. Progression and magnetic resonance imaging (MRI) finding were atypical with rapidly advancing secondary changes to the spinal cord. The outcome was fatal. The patient was admitted with a history of two-month progression of weakness and numbness of the lower limbs. Low-grade glioma of the spinal cord was suspected. MRI of the spinal cord had repeatedly been interpreted as myelitis. A finding of pleocytosis in the cerebrospinal fluid supported the hypothesis of inflammatory aetiology. Atypical cells with malignant characteristics were found in the cerebrospinal fluid. Antibiotics, antiviral drugs and corticosteroids were administrated. Nevertheless, clinical and MRI findings progressively deteriorated. Because intradural haematoma was suspected, surgical decompression was performed five days after admission. Histological examination of the removed tissue corresponded to anaplastic astrocytoma converted into glioblastoma. Over the next few days, the patient developed respiratory insufficiency requiring artificial lung ventilation. The patient died of septic shock resulting from ventilator-associated pneumonia two days after the diagnosis, the 11th day of hospitalization. Autopsy confirmed glioma that, however, was localized in the caudal part of the spinal cord only. Only secondary changes - oedema and segmental haemorrhage - occurred in the remaining part of the spinal cord up to the medulla oblongata. There was no confirmed meningeal infiltration despite the presence of tumour cells in the cerebrospinal fluid.