December 28, 2015
A 75-year-old woman on warfarin with sudden-onset occipital headache, who subsequently developed severe back pain with lower limb hyperreflexia
Cervical Schwannoma Presenting As Intracranial Posterior Fossa Subarachnoid Hemorrhage (SAH)
- Background:
- Spinal causes of intracranial SAH account for approximately 0.5–1% of cases.
- Hemorrhage from a spinal schwannoma is an extremely rare cause of intracranial SAH, but anticoagulation is considered a risk factor.
- Clinical Presentation:
- Present with sudden-onset headache, often associated with backpain or myelopathic signs.
- Key Diagnostic Features:
- Patients presenting with an SAH and a disproportionate amount of blood in the foramen magnum and posterior fossa should raise the suspicion for a spinal source. Examination should look for myelopathic symptoms.
- In this setting, an MRI of the whole spine should be performed to exclude a spinal cause.
- Differential Diagnosis:
- Trauma
- Vascular malformation
- Tumor-conus ependymoma (most common)
- Dissecting spinal artery aneurysm
- Treatment:
- Surgical removal of the nerve sheath tumor. (In our case, surgical removal confirmed a spinal schwannoma.)
