Resident Physician, NYU Grossman School of Medicine n/a Long Island City, New York
Case Diagnosis: 67-year-old female with significant cord compression at T6 found to have Grade 1 spinal meningioma.
Case Description or Program Description: The patient is a 67 year old female with a history of fibroids and previous hernia who presented with bilateral lower extremity weakness, right greater than left, progressing over the last few weeks. The patient endorses numbness, impaired sensation, and muscular weakness in the bilateral lower extremity. As per Neurology, MRI of thoracic spine obtained and revealed an intradural extramedullary mass causing significant cord compression. The patient had a laminectomy and resection of tumor performed by neurosurgery. The patient also received a dexamethasone taper due to cord edema. Shortly after during her rehab stay, the patient’s bilateral lower extremity weakness gradually improved. However, she continued to have burning in her bilateral lower extremities, for which she required increasing doses of gabapentin and oxycodone.
Assessment/Results: MRI of spine revealed an intradural extramedullary mass suspicious of meningioma vs schwannoma causing significant cord compression with associated edema. Surgical pathology later identified the mass as a Grade 1 meningioma which will require outpatient follow up.
Discussion (relevance): This case demonstrates the challenges in treating neuropathic pain in a patient who underwent surgical resection of a spinal meningioma. Perhaps this indicates lasting damage to the sensory segments of the spinal cord even after resection of the space occupying lesion.
Conclusions: Neuropathy can be a lasting symptom of spinal cord compression caused by a mass occupying lesion even after resection of the mass.
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