Spinal schwannoma presenting with intraspinal hematoma: a case report and review of the literature

J Med Case Rep. 2024 Dec 21;18(1):633. doi: 10.1186/s13256-024-04968-4.

Abstract

Background: Spinal schwannomas presenting with an intraspinal hematoma or subarachnoid hemorrhage are extremely rare, and patients often have severe spinal cord compression symptoms. However, the mechanism underlying the bleeding remains unclear.

Case presentation: We present the case of a 53-year-old Chinese female diagnosed with a T12 schwannoma accompanied by an intratumoral hematoma. The patient suddenly experienced unbearable pain in the lower limbs. An emergency operation was necessary, and during surgery, we resected a tumor and evacuated a hematoma. We found a spinal nerve root fracture, intratumoral congestion, tumor capsule rupture, and bleeding. Pathological analysis indicated a schwannoma.

Conclusion: Injury to the nerve roots and vessels during motion, nerve root torsion, twisting, venous obstruction, tumor congestion, swelling, and capsule rupture are important processes in spinal schwannoma hemorrhage. Early diagnosis and proactive surgery are key points for treatment.

Keywords: Intratumoral hematoma; Schwannoma; Spinal tumor; Subarachnoid hemorrhage.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Female
  • Hematoma / diagnostic imaging
  • Hematoma / surgery
  • Humans
  • Magnetic Resonance Imaging
  • Middle Aged
  • Neurilemmoma* / complications
  • Neurilemmoma* / diagnostic imaging
  • Neurilemmoma* / pathology
  • Neurilemmoma* / surgery
  • Spinal Cord Neoplasms / complications
  • Spinal Cord Neoplasms / diagnosis
  • Spinal Cord Neoplasms / diagnostic imaging
  • Spinal Cord Neoplasms / surgery
  • Spinal Neoplasms / complications
  • Spinal Neoplasms / diagnostic imaging
  • Spinal Neoplasms / surgery
  • Spinal Nerve Roots / diagnostic imaging
  • Spinal Nerve Roots / pathology