Cerebellar Medulloblastoma with Intraspinal Metastasis Presenting with Acute Paraplegia: A Case Report

A 4-year-old girl was referred to the emergency department with urinary retention and paraplegia . She had constipation for one week prior to the admission. She also suffered from progressive weakness which had progressed to complete paralysis of both legs within four days. On examination, she was alert, with sensory loss below the level of T10. Sensation was normal in both arms. The muscle power was grade 5 in both arms but 0 in both legs. Deep tendon reflexes were absent in both legs. The laboratory data was not contributory. Under the impression of spinal lesion, emergency spinal magnetic resonance imaging (MRI) study was performed. The spinal MRI showed two intradural lesions, one in the cervicothoracic region extending from C3 through T3 and the other at the thoracolumbar junction extending from T9 through L1 (Fig. 1). The cervical spinal cord was enlarged with central hyperintensity on T2weighted images. This lesion showed no enhancement after contrast media administration, suggesting edematous changes in the spinal cord. The T10 lesion with hyperintensity on T1weighted images was an intradural extramedullary bulging mass with hemorrhage confirmed during surgery (Fig. 2). After use of intravenous contrast, the nodular thickened dorsal dural sheath was enhanced. In addition, a heterogeneously enhanced mass involving the vermis and the 4th ventricle was identified incidentally on sagittal images of cervical spine MRI (Fig. 3). There was abnormal nodular enhancement within the cisterns of the posterior fossa. Brain MRI examination revealed no other intracranial lesions. Suboccipital craniectomy for the posterior fossa tumor was performed three days after admission, disclosing a tumor invading the vermis and cerebellar peduncle and spreading over the 4th ventricle and foramen magnum. The pathologic findings confirmed that it was a medulloblastoma. Exploration of the spine at the T10 level showed blood clots and discrete granular tissue on the surface of the cord. A lobulated mass protruded from the cord into the thoracolumbar subarachnoid space. Metastatic medulloblastoma was revealed by histopathologic examination. Over the following months, this girl received radiotherapy and chemotherapy. Serial follow-up CT and MRI images showed shrinkage of the upper spinal cord lesion but progression of hydrocephalus. She died of pancytopenia and pneumonia six months after surgery. Chin J Radiol 2000; 25: 255-258 255