Thoracic and Lumbar Intraspinal Tumours Associated with Increased Intracranial Pressure.

tt is easy to comprehend that spinal cord tumours located in the cervical region or the cervico-cranial junction can produce symptoms of increased intra-cranial pressure by mechanical obstruction of the spinal fluid pathway. It is more difficult to rationalize , however, the occurrence of these symptoms with tumours in the thoracic and lumbar spine. The rarity of this incidence is supported by the fact that only 19 cases were found in the literature. One such case encountered by the author prompted the present report. The pertinent and interesting findings associated with it and those from the literature will be discussed.sion the child was thrown forward while riding in a car but sustained no obvious injuries. Several days later she became fretful and irritable, and was referred to a local hospital. Cervical spine films were interpreted as minimal dislocation of C4 and C5. At lumbar puncture the spinal fluid was pinkish-xanthochromic with an increased protein content. She was placed in cervical traction for two weeks. A month before the automobile accident, the mother had noticed weakness in the child's right leg and urinary hesitancy. While in cervical traction, this weakness and a foot drop became more evident and prompted her transfer. On examination, the tendon reflexes and sensation were normal. The right leg was weak with loss of spontaneous movements. On several occasions a right ankle clonus was elicited. A lumbar puncture revealed an opening pressure of 135 mm. of water, the fluid was xanthochromic, and clotted spontaneously. The protein content was 2,200 mg. per 100 ml. Repeat spine films showed only a slight scoliosis to the left in the thoraco-lumbar area. A myelogram disclosed a complete block of the dye column with an irregular outline at the L, vertebra. A laminectomy was carried out and at the level of TIo to L, an oval-shaped, discoloured area was exposed which was soft to palpation and quite well demarcated from the adjacent compressed spinal cord. According to the operation note the tumour was completely removed. The histology of the tumour was of a fibrillary astrocytoma (Fig. 1). The child's post-operative course was uneventful and at her discharge in November 1948 her right leg was still weak. Sensation was intact and the reflexes in the right leg were diminished. She was started on an intensive programme of physical therapy until she was able to walk unassisted. She was re-admitted on 27 April 1949 …