Abstract

A 38- year-old man with tetraplegia was admitted as an emergency patient after he had tripped and fallen.
HISTORY. During the last 5 years the patient experienced pain and severe stiffness in the region of the neck and left shoulder, which was releaved with physiotherapy. In the past year he suffered weakness of the left hand and hand muscle athrophy. During the last six months these complaints were accompanied with weakness of the legs as a consequence of which he was unable to work. Until this time he had not presented to the doctor. On admission he had total paraplegia of the legs and distally progressive paresis of both hands.
CT AND MRI INVESTIGATION demonstrated destruction of the C5, C6, C7 and Th1, Th2 vertebrae due to tumour. The intraspinal part of the tumour compressed the spinal cord and an extensive spinal cord oedema was visible on MRI. On the day of admission in emergency C5–Th1 laminectory and a decompression of the spinal cord were performed. It was impossible to radically remove the paraverhaiguse  tebral part of the tumour owing to its extensive penetration into the paravertebral tissue.
HISTOLOGICAL ANALYSIS demonstrated atypical plexiforma neurofibrom a with low mitotic activity. Neurological status remained unchanged after the operation.
COMMENT Giant neurofi bromas in the region of the spine are relatively rare. In the present case the patient did not pay adequate attention to the gradually increasing weakness of his hand and legs and did not seek medical aid until tetraplegia had developed. Many patients complain of neck and shoulder pain which is usually caused by degenerative processes in the spine or overstrain. In some cases severe medical conditions – primary or metastatic tumours,or various haematological diseases or inflammation – may cause similar signs. Younger persons with permanent pain in the region of the spine, in particular, need careful medical examination including X-ray, and CT and MRI investigations in order to timely detect these conditions.