835 - Hidden Intruder: A Case of Spinal Schwannoma Becoming Symptomatic After Mechanical Injury

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

AK

Arian Khoshgowari, DO

PGY-1 Transitional Year Resident
Baptist Health - University of Arkansas for Medical Sciences
North Little Rock, Arkansas, United States
JA

Jacob G. Austin, DO

PGY-1Preliminary Year Resident
Kirk Kerkorian School of Medicine at University of Nevada Las Vegas
Las Vegas, Nevada, United States

Co-Author(s)

EM

Ellie Mueller, BS

Medical Student
New York Institute of Technology College of Osteopathic Medicine
Philadelphia, Pennsylvania, United States

Corresponding Author(s)

KH

Kenton Hagan, MD

Attending Physician
Advanced Orthopedic Specialists
Fayetteville, AR, Arkansas, United States

Case Diagnosis: Spinal Schwannoma

Case Description: A 61-year-old male presents with acute on chronic low back pain precipitated by a misstep into a pothole 3 weeks ago. He experiences bilateral lower extremity numbness and tingling in a pattern resembling an L5 radiculopathy. The pain and weakness have progressed, now altering his gait and limiting his daily activities. Movement exacerbates his symptoms and is noted to have bilateral reduction in lower extremity strength on exam. Radiographs of the lumbar spine are negative for acute osseous abnormalities. He reports experiencing similar symptoms one year prior after a fall, which resolved following a corticosteroid taper. He is prescribed another course of steroids but returns nine days later after no improvements, prompting further imaging. MRI revealed a two-centimeter spherical contrast-enhancing lesion on the L4 nerve root compressing the central canal, most consistent with schwannoma. The patient is referred to a neurosurgeon, and the patient returns to baseline following surgical resection.

Discussions: Spinal schwannomas have been implicated as a cause of radiculopathy but have yet to document a case detailing the diagnosis of a schwannoma that only becomes symptomatic following a jarring injury. This patient’s presentation suggests that symptom onset may be mechanically related and as such may follow a resolving and recurring pattern that can mimic a multitude of more common spine pathologies.

Conclusions: Although uncommon, maintaining a broad differential of causes of lumbar radiculopathy, including but not limited to spinal schwannoma, is important as early recognition and timely intervention may have implications in preserving neurological function, assessment for malignancy, and improving treatment outcomes.