Findings
On axial and sagittal T1-weighted images (Figure 1 and Figure 4), the lesion is slightly hypointense compared with the spinal cord. There is marked compression of the spinal cord. On the sagittal T2-weighted image (Figure 2), the lesion is hyperintense relative to the spinal cord. After the administration of gadolinium (Figure 3 and Figure 5), the lesion enhances intensely and homogeneously, which is typical for a hemangioma.
Diagnosis: Spinal epidural capillary hemangioma
Purely epidural hemangiomas account for up to 12% of all spinal hemangiomas, the large majority of which are located in the vertebral bodies, with occasional epidural extension. When purely epidural hemangiomas occur, they tend to develop in the thoracic spine, less often in the lumbosacral spine, and only rarely in the cervical spine. Extension to the paravertebral space with neural foraminal widening and adjacent bony erosion is common. The lesion is generally located in the posterior spinal canal, and frequently partially encircles the spinal cord. They are usually solitary lesions, but may be associated with hemangiomas in other parts of the body, including cutaneous vascular lesions.
Symptoms tend to be gradual in onset, and include back pain, leg weakness, ataxia, parasthesias, and eventually paraparesis. Symptoms may be brought on acutely, most often secondary to trauma. Microhemorrhage in the lesion, which may occur with even minor trauma, can cause an increase in mass effect of the lesion with sudden worsening of, or acute onset of symptoms. Exercise, systemic infection, pregnancy, rapid change in posture, or straining can also cause acute onset of symptoms.
The differential diagnosis for capillary or cavernous epidural hemangioma includes lymphoma, meningioma, neurogenic tumors, epidural hematoma, epidural abscess, metastatic disease, and extramedullary hematopoiesis. Epidural hemangiomas tend to have very consistent imaging characteristics, and are generally isointense to the spinal cord on T1-weighted images, hyperintense on T2-weighted images, and demonstrate intense, homogeneous enhancement after administration of contrast. This specific constellation of imaging characteristics may help distinguish an epidural hemangioma from the other lesions in the differential diagnosis. In addition, a thin rim of low-signal intensity is often visible surrounding the lesion on both T1- and T2-weighted images, which often helps establish the lesion to be truly epidural, rather than extramedullary but intradural.
Treatment involves surgical resection, and complete resection often results in complete neurologic recovery. However, intraoperative bleeding (due to the vascular nature of the tumor) or intrathoracic extension may prevent complete excision.
There was a time in my youth when I felt immortal.
RispondiEliminaI was strong. Healthy. Full of life.
Maybe like you, I felt like I could conquer the world.
Every day I'd wake up, bursting with energy. Feeling unstoppable.
I'd go out and exercise full out. Or put in a long day at work. Or go on a weekend adventure with friends to the mountains.
And at the end of the day? I'd still feel REALLY good.
Tired, but in a good, relaxing, "hit the sack" kinda way.
Until one day, it happened.
I was getting out of the car and for some reason, I twisted my back.
It immediately seized up. Hunched over with hand on my hip, my muscles spasmed as if to protect it.
The pain was sharp. Deep. Crippling.
That was a day I'll never forget. That was the day I realized... I was human.
Getting out of the car was something I'd done a thousand times before. Why did it happen THAT day, I wondered?
I've replayed it a thousand times in my head, but I'll never know.
What I do know is that day set off a chain reaction of events.
Over the years, more unexpected bouts of pain. Days and even weeks off work.
Make-you-feel-like-a-zombie pain pills.
Physical therapy. Alternative therapy. Chiropractic.
Days of "bed rest" watching Jerry Springer.
Oh, I hated that term "bed rest." It's so not me.
Ever since that fateful day, every so often out of the blue, I'll tweak my back again and relive that fateful day as well as the weeks afterward, nursing it back to health.
Until recently.
While I was experiencing my most recent painful bout, one of my business partners took pity and shared with me a wonderful natural method that not only relieves back pain in less than 20 minutes, but there's a strong likelihood you'll never have to deal with it again.
Imagine that!
I tried it and amazingly, it worked! Within just a few minutes, my back magically "unlocked." The relief was like a warm south Pacific wave, relaxing every muscle in my body.
After wasting thousands of dollars on useless remedies, days and weeks off work, I was FINALLY FREE from pain.
I'll be honest. As I've grown older, my experience with back pain has humbled me. When I look at it the right way, maybe it WAS a good thing, because I no longer take my health and body for granted.
But the great thing is I'm back doing the things I love. Without giving second thought to whether my back will "go out." With this unique method, it's been months since I've experienced even the smallest inkling of pain...
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All I can say I wish I'd know about this method sooner. But I thank my lucky stars I found it when I did.
To your health,