Spinal coning after lumbar puncture in a patient with undiagnosed giant cervical neurofibroma
A 34-year-old man presented to a general physician with complaints of lower limb weakness and inability to stand that was worsening over 2 weeks. He had no sensory deficits. All reflexes were hypoactive. There was no sphincter involvement. A diagnosis of Guillain-Barre syndrome was made. He underwent lumbar puncture following which his weakness markedly worsened within 2 h, along with loss of lower limb sensation as well. Furthermore, he developed urinary retention and had to be catheterized. The lumbar puncture was essentially normal except for marginally elevated protein levels. Opening pressure was not documented.\nA computed tomography (CT) brain was done and was found to be normal. He then underwent magnetic resonance imaging (MRI) of the cervical and dorsal spines and was found to have an extramedullary intradural lesion with obliteration of the spinal subarachnoid space extending from C3–C4 to D3 levels [Figures -].\nOn admission to our institute, he was found to have Grade 3/5 power in bilateral biceps and deltoids with complete loss of power (Grade 0/5) in all other muscles of both lower and upper limbs. He had complete loss to all modalities of sensation below D5 dermatome. He was referred to our hospital where he underwent C2 to D3 laminoplasty and total excision of the lesion []. The lesion was intradural but extramedullary. It was present posterior to the denticulate ligament and anterior to the dorsal roots, and was attached to a dorsal rootlet at C6 level. It had a good arachnoid plane all around with no extraforaminal extension.\nHistopathology was reported as a neurofibroma.\nHe had slow postoperative improvement, and recovered motor power, sensory capabilities, and sphincter control over 1 year. After 8 years, except occasional neck pain he has no deficits.