A 44-Year-Old Man With Progressive Weakness and Back Pain

Benjamin O. Cornwell, DO; Jignesh Modi, MD


November 26, 2018

Several types of hemangiomas can occur within the epidural space of the spine. They are classified by the predominant type of vascular channel. The different types include cavernous, capillary, arteriovenous, or venous. The most common type is cavernous, which was the type of hemangioma seen in this patient's case. Little information is available in the literature about capillary, arteriovenous, and venous hemangiomas. In a Canadian case report, a 57-year-old male with a spinal epidural capillary hemangioma initially presented with low thoracic spine pain; extension of the strongly enhancing mass was seen on MRI into the adjacent foramina at 2 levels on 1 side.[8] Although no significant changes were noted radiologically, progressive myelopathy occurred over a 2.5-year period, which was treated surgically, with good recovery.[8] Arteriovenous and venous hemangiomas are frequently detected as small cystic masses, whereas the cavernous and capillary types have been reported to usually appear as solid hypervascular masses.[2]

The patient in this case reported progressive bilateral lower extremity weakness and numbness for 6 months prior to presentation. He also had been experiencing low back pain that would radiate down his right leg for approximately 4 years. He had several associated abnormal findings on his neurologic examination. Following surgery, the patient remained in the hospital for 2 days and did not experience any postoperative complications. At his first outpatient follow-up examination 9 days after surgery, he reported mild residual decreased sensation in his feet and mild weakness in his right great toe. When he returned 27 days after surgery, he had completely recovered sensation and strength in his lower extremities.


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