spinal cord neoplasm

Etiology: 1) extradural a) metastatic b) chordoma 2) intradural/extramedullary tumors a) schwannomas, meningiomas most common - meningiomas arise preferentially at foramen magnum and thoracic spine b) other - vascular tumors, chordomas, epidermoids 3) intramedullary tumors a) ependymomas - 40% - most involve conus medullaris and cauda equina b) astrocytomas of low - mid anaplasia next most common - distributed throughout spinal cord c) oligodendroglioma, ganglioglioma, medulloblastoma, hemangiomas, hemangioblastomas less common Epidemiology: - ~10% - 19% of primary CNS tumors Pathology: - most tumors extradural - most primary tumors intradural Clinical manifestations: 1) sensorimotor spinal tract syndrome a) due to compression of cord b) gradual onset over weeks to months c) initial presentation asymmetric d) motor symptoms predominate e) dorsal column involvement - paresthesia on contralateral side to motor weakness 2) radicular spinal cord syndrome a) external compression & infiltration of spinal cord roots b) sharp pain in distribution of sensory nerve root c) exacerbated by maneuvers that increase intracranial pressure (ie coughing) d) local paresthesia e) impairment of pain & touch sensations f) weakness and muscle wasting 3) central syringomyelic syndrome a) destruction & cavitation in central gray matter b) lower motor neuron destruction with segmental muscle weakness, muscle wasting & loss of reflexes c) dissociated loss of pain & temperature sensation with preservation of touch initially

Specific

benign spinal cord neoplasm spinal cord malignancy

References

Cancer, Principles and Practice of Oncology; 6th ed. deVita et al (eds); Lippincott, Williams & Wilkins, 2001, pg 2152-4