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Case Report

Disc herniation or ependymoma recurrence?

Aristeidis H. Katsanos , Ioannis Sarmas , Sotirios Giannopoulos , Sigliti-Henrietta Pelidou , Athanassios P.
1,2
1
1,2
1
Kyritsis 1,2
1 Department of Neurology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece.
2 Neurosurgical Intitute, School of Medicine, University of Ioannina, 45110 Ioannina, Greece.
A B S T R AC T
In this paper, a 41-year-old female with previous history of ependymoma is reported. The patient underwent gross-total resection of
the tumor and ventriculo-peritoneal shunt placement, followed by radiotherapy to the posterior fossa and the upper-cervical spinal
cord region. Three years later she developed numbness in her right arm, body and leg. Magnetic resonance imaging (MRI) of the
entire neuraxis revealed no evidence of tumor recurrence, while a small enhancing area was noted in the left anterolateral spinal
cord at the level of the C1-C2 vertebrae and a left posterior-lateral herniated disk in the C5-C6 level which was not present in the
earlier MRI at initial diagnosis. Lumbar punctures were negative for malignant cells. The patient’s symptoms were first attributed
to radiation-induced effect. Follow-up results of brain and the cervical spine MRI were performed which showed disappearance
of the small abnormality in the left C2 spinal cord area but persistence of the herniated C5-C6 disk. Thus, the current diagnosis
of right-sided numbness due to pressure of the left anterolateral spinothalamic tracts from the herniated C5-C6 disk was made.
This is a unique case, in which herniated disk pressuring effects needed to be differentiated from both radiation-induced treatment
effect and tumor recurrence.

Key words: Disc herniation; ependymoma recurrence; radiotherapy

INTRODUCTION treated ependymoma needed to be differentiated from
radiation-induced injury and tumor recurrence.
Most of the intracranial ependymomas in adults
are supratentorial in contrast to the childhood CASE REPORT
[1]
ependymomas that are usually infratentorial.
According to the World Health Organization (WHO)
they are classified into grades I, II and III. Grade ependymoma presented to the Neurology clinic for
[2]
I includes the myxopapillary ependymoma and persisted numbness in her right arm, body and leg of
subependymoma; grade II is the most common variant 10-month duration. The patient was diagnosed 3 years
and grade III is the anaplastic variant. Gross total earlier with hydrocephalus due to a fourth ventricular
resection followed by limited-field radiotherapy is the ependymoma, without evidence of cerebrospinal fluid
standard form of treatment in uncomplicated cases. [3,4] (CSF) seeding in magnetic resonance imaging (MRI)
Craniospinal radiation should be reserved only for of the brain or the entire spine [Figure 1]. At that time,
cases where there is documented leptomeningeal she underwent gross-total resection of the tumor and
seeding. [1,5] Radiation necrosis is a rare complication ventriculo-peritoneal shunt placement, followed by
[6]
(< 5%) of conventional radiotherapy, but when it 6,000 rads radiotherapy to the posterior fossa and
does occur it poses a challenge to differentiate from the upper-cervical spinal cord region. Approximately
tumor recurrence. [7,8] We report herein a unique case 10 months prior to her visit to our clinic, the patient
where a herniated disk in a patient with a previously developed unilateral numbness in her right arm,
body and leg, worse in the leg than in the arm.
Corresponding Author: Dr. Aristeidis H. Katsanos, MRI of the entire neuraxis revealed no evidence of
Department of Neurology, School of Medicine, University of tumor recurrence. However, a small enhancing area
Ioannina, Stavros Niarchos Avenue, 45110 Ioannina, Greece.
E-mail: ar.katsanos@gmail.com
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Cite this article as: Katsanos AH, Sarmas I, Giannopoulos S, Pelidou SH,
Kyritsis AP. Disc herniation or ependymoma recurrence? Neuroimmunol
DOI:
10.20517/2347-8659.2015.42 Neuroinflammation 2016;3:65-8.
Received: 30-09-2015; Accepted: 05-01-2016

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