Neurochirurgia 22 (1979) 194-195 © Georg Thieme Verlag Stuttgart
Paraplegia due to Bilateral Angioma of the Paracentral Area C. Arseni, P. Decu
Summary The authors present a case of bilateral angioma of the paracentral area with paraplegia and generalized epileptic seizures. The onset of the disease was after a head injury. Key-Words: Bilateral paracentral angioma Paraplegia - Epileptic seizure - Head injury
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Zusammenfassung Paraplégie als Folge eines bilateralen Angioms der parazentralen Ära Die Autoren beschreiben einen Fall von bilateralem Angiom der Parazentralregion mit Paraplégie und generalisierten epileptischen Anfällen. Die Erkrankung begann nach einem Schädelhirntrauma.
The onset of the disease, the clinical aspect and rare occurence of paraplegia due to bilateral angioma of the paracentral area warrants brief publication of the case. The patient B. R., 65 years old, was admitted in 2nd degree coma. At the age of 23 years, in perfect health he suffered a head injury while playing rugby and remained comatose for several days. He recovered but with paraplegia and paresis of the left arm. Remission of the left brachial paresis occured within a year but paraplegia persisted and at rare intervals of months, or even a year, he exhibited generalized epileptic seizures with a motor onset in the left lower extremity, under phénobarbital and phenytoin treatment. The diagnosis was head injury with predominant cerebral contusion of the paracentral area and associated epilepsy. For moving about more easily the patient used a tricycle. On the day of admission, he was riding on his tricycle by the side of a lake when
he lost control and plunged into the water without hitting his head. He lost consciousness and was transported to hospital, where he was admitted in second degree coma and without external signs of head injury. The cerebrospinal fluid (CSF) was intensely haemorrhagic and paraplegia with slight left brachial paresis was noted. Right carotid arteriography revealed an angioma of the right paracentral area (Fig. 1). Ten days later, left carotid angiography showed another angioma in the left paracentral area (Fig 2). Vertebral arteriography was normal. The patient refused the operation and was discharged after 20 days with paraplegia (spastic gait possible with a walking stick, brisk deep tendon reflexes of the lower limbs, bilateral Babinski) without sensory changes or sphincter disturbances.
Discussion Cortical paraplegia caused by double lesion of the paracentral area is somewhat more frequent in head injuries (in a statistical material of 20,000 craniocerebral injuries, we had four cases of paraplegia due to penetration of the bone and one case due to a firearm wound with injury of both paracentral areas), rare in cerebral tumours (of 190 meningiomas of the paracentral area, 15 were bilateral but only 4 presented with paraparesis and Jacksonian fits alternating in the lower extremities) and of 464 unilateral angiomas and 18 bilateral angiomas this was the only case with two separate angiomas. After the head injury while playing rugby haemorrhage developed in both angiomas, followed by coma and paraplegia; while riding on his tricycle he probably had a generalized convulsive seizure and fell into the lake.
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Clinic of Neurosurgery, Bucharest, and Neurosurgerical Department, Constanta — Romania
195
Fig. 2: Left carotid arteriography, AP and lateral view. Note the presence of angioma in the left paracentral lobule fed by the pericallosal artery.
No similar case has previously been published in the medical literature. The case is of interest by its uniqueness and because it shows that even in apparently simple events investigations must be as complete as possible. inica de Neurochirurgie, Sos. Bercent 10, Bucuresti, Romania
13*
Downloaded by: National University of Singapore. Copyrighted material.
Paraplegia due to Bilateral Angioma of the Paracentral Area
Paraplegia due to Bilateral Angioma of the Paracentral Area C. Arseni, P. Decu
Summary The authors present a case of bilateral angioma of the paracentral area with paraplegia and generalized epileptic seizures. The onset of the disease was after a head injury. Key-Words: Bilateral paracentral angioma Paraplegia - Epileptic seizure - Head injury
-
Zusammenfassung Paraplégie als Folge eines bilateralen Angioms der parazentralen Ära Die Autoren beschreiben einen Fall von bilateralem Angiom der Parazentralregion mit Paraplégie und generalisierten epileptischen Anfällen. Die Erkrankung begann nach einem Schädelhirntrauma.
The onset of the disease, the clinical aspect and rare occurence of paraplegia due to bilateral angioma of the paracentral area warrants brief publication of the case. The patient B. R., 65 years old, was admitted in 2nd degree coma. At the age of 23 years, in perfect health he suffered a head injury while playing rugby and remained comatose for several days. He recovered but with paraplegia and paresis of the left arm. Remission of the left brachial paresis occured within a year but paraplegia persisted and at rare intervals of months, or even a year, he exhibited generalized epileptic seizures with a motor onset in the left lower extremity, under phénobarbital and phenytoin treatment. The diagnosis was head injury with predominant cerebral contusion of the paracentral area and associated epilepsy. For moving about more easily the patient used a tricycle. On the day of admission, he was riding on his tricycle by the side of a lake when
he lost control and plunged into the water without hitting his head. He lost consciousness and was transported to hospital, where he was admitted in second degree coma and without external signs of head injury. The cerebrospinal fluid (CSF) was intensely haemorrhagic and paraplegia with slight left brachial paresis was noted. Right carotid arteriography revealed an angioma of the right paracentral area (Fig. 1). Ten days later, left carotid angiography showed another angioma in the left paracentral area (Fig 2). Vertebral arteriography was normal. The patient refused the operation and was discharged after 20 days with paraplegia (spastic gait possible with a walking stick, brisk deep tendon reflexes of the lower limbs, bilateral Babinski) without sensory changes or sphincter disturbances.
Discussion Cortical paraplegia caused by double lesion of the paracentral area is somewhat more frequent in head injuries (in a statistical material of 20,000 craniocerebral injuries, we had four cases of paraplegia due to penetration of the bone and one case due to a firearm wound with injury of both paracentral areas), rare in cerebral tumours (of 190 meningiomas of the paracentral area, 15 were bilateral but only 4 presented with paraparesis and Jacksonian fits alternating in the lower extremities) and of 464 unilateral angiomas and 18 bilateral angiomas this was the only case with two separate angiomas. After the head injury while playing rugby haemorrhage developed in both angiomas, followed by coma and paraplegia; while riding on his tricycle he probably had a generalized convulsive seizure and fell into the lake.
Downloaded by: National University of Singapore. Copyrighted material.
Clinic of Neurosurgery, Bucharest, and Neurosurgerical Department, Constanta — Romania
195
Fig. 2: Left carotid arteriography, AP and lateral view. Note the presence of angioma in the left paracentral lobule fed by the pericallosal artery.
No similar case has previously been published in the medical literature. The case is of interest by its uniqueness and because it shows that even in apparently simple events investigations must be as complete as possible. inica de Neurochirurgie, Sos. Bercent 10, Bucuresti, Romania
13*
Downloaded by: National University of Singapore. Copyrighted material.
Paraplegia due to Bilateral Angioma of the Paracentral Area
