Case report
Spinal angiolipoma with acute subarachnoid hemorrhage

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Abstract

Angiolipoma is a rare tumor of the spine commonly presenting with compressive myelopathy. We report a spinal angiolipoma in a 14-year-old patient with acute spinal subarachnoid hemorrhage (SAH). To our knowledge this is the first reported case of a spinal angiolipoma presenting with SAH, associated with post-subclavian coarctation with diffuse hypoplasia of the descending aorta. This association of coarctation of aorta, aortic hypoplasia and spinal angiolipoma has also not been reported previously.

Introduction

Spinal angiolipoma is a rare tumor of the spinal axis. It usually presents with features of compressive myelopathy.1 Subarachnoid hemorrhage (SAH) from spinal angiolipoma has not previously been reported.

Section snippets

Case report

A 14-year-old boy presented with acute-onset back and nuchal pain, with opisthotonic posturing and bifrontal headache of 6 days’ duration. He had mild non-progressive limping gait for the past 8 years. He had also undergone surgical correction of coarctation of aorta 2 years previously. On examination he was febrile, his blood pressure was 174/100 mmHg in the upper limbs, 190/100 mmHg in the lower limbs and he had grade II hypertensive retinopathy changes. There was severe neck rigidity,

Discussion

Spinal angiolipomas are rare benign tumors of the spine, accounting for about 0.04–1.2% of all spinal tumors.1 Angiolipomas are extremely rare in children with only a few cases reported in the literature.[1], [2], [3] Spinal angiolipomas commonly occur in the mid-thoracic region, are predominantly epidural and only less than 5% are intramedullary.4

While the more common non-infiltrating angiolipomas are located mainly in the posterior epidural space, infiltrating angiolipomas are generally seen

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    The common initial symptoms were progressive or sudden paraparesis, thoracic or lumbar pain, and diverse sensory disturbances.1,2 Pregnancy was assumed to be an aggravating factor for epidural SA in 15.5% of the 77 female patients reported.1,2,4–10 In rare instances, SA manifested as acute epidural or subarachnoid hemorrhage in non-pregnant patients.

  • Spinal angiolipoma: Presentation of two cases and review of the literature for the years 2012–2017

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    In addition, due to the benign and slow-growing nature of the mass, most patients present with tumours extending up to four vertebral bodies2 and with signs and symptoms of spinal cord compression. Nevertheless rare cases of paraplegia or paraparesis because of spontaneous epidural16–18 or subarachnoid haematomas19 or even intratumoural abscesses20 have also been reported as initial clinical presentations of the mass. Occasionally, the tumour may infiltrate the vertebral bodies or the adjacent soft tissues, a condition which is more common in masses of the anterior compartment.21

  • Intranodal angiolipoma

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