Two Cases of Spinal Cord Ependymoma Concomitant With Hydrocephalus and Intracystic Hemorrhage

Abstract

Background & Significance: Ependymoma usually arises from the ventricular surface. Cervical intramedullary ependymoma concomitant with hydrocephalus and intracystic hemorrhage is very rare. We report two patients with hydrocephalus and intracystic hemorrhage due to cervical ependymoma only presented with mild headache Case: A 63-year-old man was admitted to our hospital because of headache and nausea. Headache was aggravated one month before admission. His vital signs were normal. Laboratory findings and neurologic examination were also normal. Brain and cervical magnetic resonance imaging revealed a wellenhanced intramedullary mass, suggesting ependymoma or astrocytoma, in the upper cervical (C1-C3) region, hydrocephalus, and intracystic hemorrhage. Surgical decompression and subtotal excision were done. Pathological report confirmed a diagnosis of ependymoma. A 38.year-old man visited outpatient clinic. The patient complained of a headache. His vital signs, laboratory findings, and neurologic examination were also normal. Neuroimaging showed cervicomedullary tumor concomitant with hydrocephalus due to obstruction and intracystic hemorrhage. The tumor was also diagnosed as ependymoma Conclusions or Commentes: Ependymoma rarely arises in elderly patients. Ependymoma is most frequently located in the floor of the fourth ventricle and usually induces hydrocephalus, cerebellar compression and intracranial hypertension. And neurologic deficit due to ependymoma is variable depending on its location, size and concomitant condition. Intramedullary tumor in spinal cord is very rare, accounting for <2% of all primary central nervous system tumors. Spinal cord ependymoma combined with hydrocephalus and intracystic hemorrhage has not yet been reported. Herein, we report two cases of spinal cord ependymoma at cervical level with hydrocephalus and intracystic hemorrhage. Their presenting symptom was only mild headache without any neurological deficit. Considering the neuroimaging findings of two patients, this symptom is thought to be extremely mild, although cervical ependymoma itself could cause subtle clinical signs. These cases are the first report of cervical ependymoma with hydrocephalus and intracystic hemorrhage only presenting with mild headache.