Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-30T15:06:21.452Z Has data issue: false hasContentIssue false

Clival Chordoma Presenting with Acute Brain Stem Hemorrhage

Published online by Cambridge University Press:  18 September 2015

Allan D.O. Levi
Affiliation:
Division of Neurosurgery/Neuropathology, Mississauga Hospital, Department of Neuroradiology, The Toronto Hospital, University of Toronto, Toronto
Walter Kucharczyk
Affiliation:
Division of Neurosurgery/Neuropathology, Mississauga Hospital, Department of Neuroradiology, The Toronto Hospital, University of Toronto, Toronto
Arnold P. Lang
Affiliation:
Division of Neurosurgery/Neuropathology, Mississauga Hospital, Department of Neuroradiology, The Toronto Hospital, University of Toronto, Toronto
Hart Schutz*
Affiliation:
Division of Neurosurgery/Neuropathology, Mississauga Hospital, Department of Neuroradiology, The Toronto Hospital, University of Toronto, Toronto
*
Division of Neurosurgery, Mississauga Hospital, 100 Queensway West, Mississauga, Ontario, Canada, L5B 1B8
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The authors present a case of a 29-year-old man who developed rapidly progressive cranial nerve palsies and a right hemiparesis secondary to a pontine hemorrhage. The rare but correct diagnosis of a clival chordoma which had invaded the brain stem and subsequently hemorrhaged was based on computed tomography and magnetic resonance imaging. The diagnosis was confirmed at surgery when the patient underwent a successful operative decompression of tumor and clot from the pons via a sub-occipital craniotomy. This represents the first case of a clival chordoma to hemorrhage into the brain stem, which was diagnosed preoperatively and the patient survived.

Type
Articles
Copyright
Copyright © Canadian Neurological Sciences Federation 1991

References

REFERENCES

1.Laws, ER. Cranial chordomas. In: Wilkins, RH, Rengachary, SS, eds. Neurosurgery. Vol. 1, Edition 1. New York: McGraw Hill, 1985: 927930.Google Scholar
2.Heffelinger, MJ, Dahlin, DC, MacCarty, CS, et al. Chordomas and cartilaginous tumors at the skull base. Cancer 1973; 32: 410420.3.0.CO;2-S>CrossRefGoogle Scholar
3.Sen, CN, Sekhar, LN, Schramm, VL, et al. Chordoma and chondrosarcoma of the cranial base; an 8 year experience. Neurosurgery 1989; 25: 931941.CrossRefGoogle Scholar
4.Rich, TA, Schiller, A, Suit, HD, et al. Clinical and Pathologic review of 48 cases of chordoma. Cancer 1985; 56: 182187.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
5.Larson, TC, Houser, W, Laws, ER. Imaging of cranial chordomas. Mayo Clin Proc 1987; 62: 886893.CrossRefGoogle ScholarPubMed
6.Oot, RF, Melville, GE, New, PF, et al. The role of MR and CT in evaluating clival chordomas and chondrosarcomas. AJR 1988; 151:567575.CrossRefGoogle ScholarPubMed
7.Sze, G, Uichanco, LS, Brant-Zawadski, MN, et al. Chordomas: MR Imaging. Radiology 1988; 166: 187191.CrossRefGoogle ScholarPubMed
8.Simonsen, J. Fatal subarachnoid hemorrhage originating in an intracranial chordoma. Acta Pathol Microbiol Scand 1963; 59: 1320.CrossRefGoogle Scholar
9.Eriksson, B, Gunterburg, B, Kindblom, L. Chordoma: A clinicopathologic and prognostic study of a Swedish national series. Acta Orthop Scand 1981; 52: 4958.CrossRefGoogle ScholarPubMed
10.McCormick, WF, Rosenfield, DB. Massive brain hemorrhage: A review of 144 cases and an examination of their cause. Stroke 1973; 4: 946954.CrossRefGoogle Scholar
11.Luessenhop, AJ, Shevlin, WA, Ferrero, AA, et al. Surgical management of primary intracerebral hemorrhage. J Neurosurg 1967; 27: 419427.CrossRefGoogle ScholarPubMed
12.Mutlu, N, Berry, RG, Alpers, BJ. Massive cerebral hemorrhage: Clinical and pathological correlations. Arch Neurol 1963; 8: 644661.CrossRefGoogle ScholarPubMed
13.Russell, DS. The pathology of spontaneous intracranial hemorrhage. J Roy Soc Med 1954; 47: 689693.Google Scholar
14.Wakai, S, Yamakawa, K, Manaka, S, et al. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery 1982; 10: 437444.CrossRefGoogle ScholarPubMed
15.Kondziolka, D, Bernstein, M, Resch, L, et al. Significance of hemorrhage into brain tumors: Clinicopathologic study. J Neurosurg 1988; 67: 852857.CrossRefGoogle Scholar
16.Gardner, WJ, Turner, O. Cranial Chordomas. A clinical and pathologic study. Arch Surg 1941; 42: 411425.CrossRefGoogle Scholar
17.Lazaro, RP, Messer, HD, Brinker, RA. Intracranial hemorrhage associated with meningioma. Neurosurgery 1981; 8: 96101.CrossRefGoogle ScholarPubMed
18.Gleeson, RK, Butzer, JF, Grin, OD Jr.Acoustic neurinoma presenting as sub-arachnoid hemorrhage: Case report. J Neurosurg 1978; 49: 602604.CrossRefGoogle Scholar
19.McCoyd, K, Barron, KD, Cassidy, RJ. Acoustic neurinoma presenting as sub-arachnoid hemorrhage. J Neurosurg 1974; 41: 391393.CrossRefGoogle Scholar
20.Hirano, A, Matsui, T. Vascular structures in brain tumors. Hum Pathol 1975; 6: 611621.CrossRefGoogle ScholarPubMed
21.Weller, RO, Foy, M, Cox, S. The development and ultrastrueture of the microvasculature in malignant gliomas. Neuropath Appl Neurobiol 1977; 3: 307322.CrossRefGoogle Scholar
22.Andrews, BT, Raffel, C, Rosegay, H. Subarachnoid hemorrhage from a peripheral intracranial aneurysm associated with a malignant glioma: report of a case. Neurosurgery 1985; 17: 645649.CrossRefGoogle ScholarPubMed
23.Hart, MN, Byer, JA. Rupture of middle cerebral artery branches by invasive astrocytoma. Neurology 1974; 24: 11711174.CrossRefGoogle ScholarPubMed
24.Memon, MY, Neal, A, Inami, R, et al. Low grade glioma presenting as subarachnoid hemorrhage. Neurosurg 1984; 14: 574577.CrossRefGoogle ScholarPubMed
25.Poon, TP, Solis, OG. Sudden death due to massive intraventricular hemorrhage into an unsuspected ependymoma. Surg Neurol 1985; 24: 6366.CrossRefGoogle ScholarPubMed
26.Bartolini, G IIcordoma del clivus quale causa di emorragia cerebrale: discussione anatomica-clinica su di osservazione autopica. Boll Soc It Biol Sper 1974; 50: 912918.Google Scholar
27.Stam, FC, Kamphorst, W. Ecchordosis physahphora as a cause of fatal pontine hemorrhage. Eur Neurol 1982; 21: 9093.CrossRefGoogle ScholarPubMed
28.Koga, N, Kadota, Y, Hatashita, Y, et al. A case of clivus chordoma showing hemorrhage in the posterior fossa (Jpn). No Shinkei Geka–Neurological Surgery 1988; 16: 417421.Google Scholar
29.Franquemont, DW, Katsetos, CD, Ross, GW. Fatal acute pontocerebellar hemorrhage due to an unsuspected spheno-occipital chordoma. Arch Pathol Lab Med 1989; 113: 10751078.Google Scholar