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Epidural Varix at the Cervicothoracic Junction: Unusual Cause of Quadriplegia: A Case Report

Bapat, Mihir, MD, DNB; Metkar, Umesh, MS

doi: 10.1097/01.brs.0000197173.87929.48
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Study Design. A case report describing an unusual incident of quadriplegia in a young adult male caused by an epidural varix at the cervicothoracic junction.

Objective. To report an unusual case of quadriplegia caused by an epidural varix at the cervicothoracic junction.

Summary of Background Data. Epidural varices are dilated tortuous elongated veins inside the central canal. In degenerative spinal stenosis, these varices are a result of venous stagnation and contribute to the pathogenesis of radicular pain. In the absence of stenosis, primary varicosities develop as a result of dynamic obstruction to venous outflow during spinal movements. A primary epidural varix can produce neurologic deficit similar to a space occupying lesion within the spinal canal. The myeloradiculopathy is of a slow progressive nature.

Material and Methods. A young man presented with an acute onset flaccid quadriplegia in the absence of significant trauma. Magnetic resonance imaging revealed an extradural space occupying lesion at the cervicothoracic junction that was diagnosed as an isolated epidural varix during surgery.

Results. No neurologic recovery occurred. Postoperative magnetic resonance imaging revealed a syrinx in the cervicothoracic cord.

Conclusion. In the absence of other precipitating factors, the cord injury was attributed to the epidural varix. A temporary impedance to the venous outflow with the increase in the venous pressure has been hypothesized as the mechanism of cord injury.

The epidural veins are capable of enormous dilatation during the periods of increased blood flow without developing varices. Epidural varices are rare pathologic entities capable of causing a slow progressive neural compression. Acute neurologic injury is unreported. This case report describes an unusual incident of an acute nontraumatic quadriplegia caused by an epidural varix at the cervicothoracic junction.

From the Department of Orthopedics, King Edward Memorial Hospital, Mumbai, India.

Acknowledgment date: April 5, 2005. First revision date: June 25, 2005. Acceptance date: June 27, 2005.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Mihir Bapat, MD, DNB, B1002 Jagatvidya Society, Bandra East, Mumbai 400 051, India; E-mail: mrbkemh@netscape.net

© 2006 Lippincott Williams & Wilkins, Inc.