Dados do Trabalho

Título

Hematomyelia mimicking longitudinally extensive myelitis: a case report.

RESUMO

Case presentation: A 54-year-old woman, admitted in 2016 due to sudden severe neck pain with no history of trauma, that radiated to the left side of the body, associated with decreased ipsilateral strength and sensitivity. On admission, she had hemiparesis, hyperreflexia with Babinski´s sign and hypoesthesia of left hemibody. Spinal MRI showed T2/FLAIR C1-T2 hyperintense lesion, with extensive vasogenic edema, mild hyposignal on T1-weighted gradient-echo (GRE) inside the spinal cord and gadolinium-enhancement near the spinal canal. CSF analysis with 15 leukocytes (lymphomononuclear cells predominance), 135 proteins, 79 glucose and 11275 red blood cells (puncture accident). Anti-AQP4 antibody was negative, as well as other infectious and inflammatory screening tests. The condition was attributed to a seronegative longitudinally extensive myelitis with probable inflammatory etiology and started 5 days of high-dose steroid treatment, followed by 5 sessions of plasma exchange, with no improvement in symptoms. She was maintained with prednisone and azathioprine, suspended 3 years later due to myelotoxicity. In 2019, new MRI scans showed hyposignal on GRE sequence in the subcortical region of the left inferior parietal lobe, thalamus, bulbo medullary transition and in the C1-T1 spinal cord, suggesting chronic hemorrhage. Idiopathic hematomyelia was the hypothesis made and the patient was kept without immunosuppressive, remaining stable until today.
Discussion: Hematomyelia is a hematoma in the spinal cord. There are few published case reports about vascular myelopathy caused by this entity. The etiology can be traumatic (most common) or non-traumatic. Idiopathic hematomyelia is the term used when spontaneous intraspinal bleeding occurs without a clear etiology. Myelopathy occurs due to the mass effect caused by the hematoma, that acutely obstruct the cerebrospinal fluid and blood flow within the spinal cord. The symptoms presented are intense and sudden pain in the neck and back, evolving rapidly (in hours to days) to myelopathic deficits. Recent studies have shown that patients initially diagnosed with idiopathic transverse myelopathy often have alternative diagnoses, with vascular etiology being one of the most common.
Conclusion: Recognize that hematomyelia can cause extensive spinal cord injury and can mimic an autoimmune longitudinally extensive myelitis is of fundamental importance, allowing for prompt recognition and management for better outcomes.

Palavras Chave

Hematomyelia; longitudinally extensive myelopathya.