SCI
Alexa Malik, MD
Resident Physician
University of Missouri-Columbia PM&R Program
Columbia, Missouri, United States
Mark Drymalski, MD
Attending Physician
University of Missouri-Columbia PM&R Program
Columbia, Missouri, United States
Alexa Malik, MD
University of Missouri Health System
Columbia, Missouri, United States
Spinal cord injury due to large thoracic meningioma
Case Description:
A 51-year-old female presented to nonoperative spine clinic with 9 months of low back pain and progressive bilateral lower extremity weakness. She progressed to experience saddle anesthesia, and bladder incontinence. Despite workup by primary care and neurosurgery, including normal brain and lumbar MRIs and failed conservative treatments (e.g., medial branch blocks), symptoms progressed. She relied on a power scooter (which she purchased out of pocket) for mobility. Physiatry referral was placed for further workup. Neurologic exam revealed hyperreflexia and asymmetric lower extremity weakness with gait dysfunction. Cervical and thoracic MRI were ordered which revealed a T2 meningioma with a C6-T1 syrinx. She underwent urgent thoracic laminectomy and tumor resection. Postoperatively, she demonstrated rapid functional gains. At 2 weeks, she reported improved strength, sensation, and bladder control; MRI showed syrinx resolution and no residual tumor. At 4 months, she had full lower extremity strength and ambulated with a cane.
Discussions:
Thoracic meningioma is a rare subset of meningiomas, which are otherwise the most common primary central nervous system (CNS) tumors in adults. The vast majority of meningiomas are intracranial, but approximately 1–12% are spinal, with a strong predilection for the thoracic spine. Spinal meningiomas are significantly more common in women, with a female-to-male ratio of approximately 2–3:1. The expected recovery after spinal cord injury caused by a spinal meningioma is generally favorable, with most patients experiencing significant neurological improvement following surgical resection. Up to 60% may achieve complete recovery at one year.
Conclusions:
Early recognition and full neuraxis imaging are critical in patients with atypical or progressive symptoms to avoid diagnostic delays. In this case, months of delayed diagnosis led to prolonged mobility impairment and financial burden, though timely surgical resection ultimately resulted in marked recovery.
