A 3-year-old boy presented with headaches, vomiting, lethargy and papilledema. Communicating hydrocephalus along with transependymal fluid absorption and meningeal contrast enhancement was identified on CT. The enhancement was initially thought to be the result of a partially treated meningitis (child was previously on oral antibiotics for a presumed mycoplasma pneumonia). A right ventricular-peritoneal shunt was placed. CSF studies procured during the procedure were all normal. In contrast, CSF from a lumbar puncture contained a high protein, and cytology was highly suspicious for malignancy. Spine MRI showed diffuse leptomeningeal enhancement and a 1.5-cm intramedullary lesion at T12–L1 associated with minimal edema. The lesion was subtotally resected (70%) and diagnosed as an astrocytoma (mostly Kernohan grade 2 but with areas of grade 3). Chemotherapy was administered and follow-up spine MRI at 2 months did not reveal any residual tumor, however, the leptomeningeal enhancement persisted. Sixteen months later, at the completion of the chemotherapy and radiation therapy, the spine MRI remained unchanged. Neurological examination has always been normal. This case illustrates how a spinal cord astrocytoma can metastasize via spinocranial dispersion and present early with hydrocephalus rather than myelopathy.

Keywords:
Hydrocephalus, Spinal cord tumor, Astrocytoma, Leptomeningeal dissemination
1.
Ammerman BJ, Smith DR: Papilledema and spinal cord tumors. Surg Neurol 1975;3:55–57.
2.
Arseni C, Maretsis M: Tumors of the lower spinal cord associated with increased intracranial pressure and papilledema. J Neurosurg 1967;27:105–110.
3.
Bell WO, Packer RJ, Seigel KR, Rorke LB, Sutton LN, Bruce DA, Schut L: Leptomeningeal spread of intramedullary spinal cord tumors: Report of three cases. J Neurosurg 1988;69:295–300.
4.
Bouffet E, Amat D, Devaux Y, Desuzinges C: Chemotherapy for spinal cord astrocytoma. Med Pediatr Oncol 1997;29:560–562.
5.
Civitello LA, Packer RJ, Rorke LB, Siegel PA, Sutton LN, Schut L: Leptomeningeal dissemination of low-grade gliomas in childhood. Neurology 1988;38:562–566.
6.
Constantini S, Houten J, Miller DC, Freed D, Ozek MM, Rorke LB, Allen JC, Epstein FJ: Intramedullary spinal cord tumors in children under the age of 3 years. J Neurosurg 1996;85:1036–1043.
7.
DeSousa AL, Kalsbeck JE, Mealey J Jr, Campbell RL, Hockey A: Intraspinal tumors in children: A review of 81 cases. J Neurosurg 1979;51:437–445.
8.
Doireau V, Grill J, Zerah M, Lellouch-Tubiana A, Couanet D, Chastagner P, Marchal JC, Grignon Y, Chouffai Z, Kalifa C for the Brain Tumours Subcommittee of the French Society of Paediatric Oncology (SFOP): Chemotherapy for unresectable and recurrent intramedullary glial tumours in children. Br J Cancer 1999;81:835–840.
9.
Glasauer FE: Thoracic and lumbar intraspinal tumours associated with increased intracranial pressure. J Neurol Neurosurg Psychiatry 1964;27:451–458.
10.
Goh KYC, Velasquez L, Epstein FJ: Pediatric intramedullary spinal cord tumors: Is surgery alone enough? Pediatr Neurosurg 1997;27:34–39.
11.
Hardison HH, Packer RJ, Rorke LB, Schut L, Sutton LN, Bruce DA: Outcome of children with primary intramedullary spinal cord tumors. Childs Nerv Syst 1987;3:89–92.
12.
Johnson DL, Schwarz S: Intracranial metastases from malignant spinal-cord astrocytoma: Case report. J Neurosurg 1987;66:621–625.
13.
Lowis SP, Pizer BL, Coakham H, Nelson RJ, Bouffet E: Chemotherapy for spinal cord astrocytoma: Can natural history be modified? Childs Nerv Syst 1998;14:317–321.
14.
Perilongo G, Gardiman M, Bisaglia L, Rigobello L, Calderone M, Battistella A, Burnelli R, Giangaspero F: Spinal low-grade neoplasms with extensive leptomeningeal dissemination in children. Childs Nerv Syst 2002;18:505–512.
15.
Schijman E, Zuccaro G, Monges JA: Spinal tumors and hydrocephalus. Childs Brain 1981;8:401–405.
16.
Zavala LM, Adler JR, Greene CS, Winston KR: Hydrocephalus and intraspinal tumor. Neurosurgery 1988;22:751–754.
© 2005 S. Karger AG, Basel
2005
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.