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CHAPTER 8
HAEMANGIOMA OF THE SPINAL CORD
Of the non-traumatic afflictions of the spinal cord, the writer has chosen this case of
angiomatous malformation as the patient combines discrete vascular abnormalities of
the cord, including thrombosis, with the effects of gradual compression of the cord.
This man, aged 30, was admitted on 18 November 1955 with an incomplete trans–
verse spinal syndrome below Ty, which was complete below Tio. The motor paralysis
was of flaccid type with areflexia. The arm reflexes were exaggerated in both upper limbs
but there was no muscular impairment or disturbance of sensibility. In November 1943
he had started with weakness in both lower limbs, more in the left than the right, which
had gradually increased, and in September 1944 he developed difficulty in starting
micturition and in controlling his bowel function. By February 1945 he had a practically
complete paraplegia below Tio and at operation at that time carried out by the neuro-
surgeon Mr Harvey Jackson, an angioma was found starting at the level of the distal
cervical segment and involving the whole spinal cord in the thoracic area. He had deep
X-ray treatment afterwards in 1945-46. In the following years he had repeated hospital
treatments elsewhere for infection of the urinary tract and pressure sores.
On admission to Stoke Mandeville he was suffering from marked renal deficiency
and hypertension 185/110, with a blood urea of 208 mg per cent, and protein excretion
of 13-1 g daily in the urine. Urine was infected with proteus. Hb 64 per cent, serum
albumin 3-55, serum globulin 2-4. He had a residual urine of 60 oz, bilateral hydro-
nephrosis and ureteric reflux. Blood transfusions combined with Bull's diet and anti–
biotics resulted in improvement of blood urea to 146 mg per cent and anaemia (79-85 per
cent Hg). The paraplegia remained unchanged. After his first discharge on 5 May 1956
he was repeatedly readmitted because of deterioration in his renal and heart insufficiency
and he died from uraemia on 24 September 1956.
The necropsy revealed a large haemangioma of the whole spinal cord with the main
vascular anomalies in the mid-thoracic and lumbosacral regions where the dilatation of
the tortuous vessels was most striking. The radicular veins of the cauda equina were
also dilated.
Microscopically, sections below Ty, including lumbar and sacral segments showed a
complete disappearance of the normal architecture of the cord and almost no distinction
between grey and white structures, while in the upper thoracic and cervical segments this
distinction was maintained. All segments were surrounded by greatly dilated vessels
many of which showed various stages of thrombosis. In Ty/8 an enormously dilated and
thrombosed vessel had invaded and compressed the spinal cord substance. There was also
a 'core' of small vessels lying proximal to the thrombosed vessel (Fig. 403). The profound
vascular proliferation within the tissues of the cord was most conspicuous in Tio and Ti i
segments, as shown in section of T9 (Fig. 4ob). The compression of the cord tissue as a
result of the invasion of a large external vessel was particularly conspicuous in Li seg–
ment, which also showed in addition to diffusely scattered vessels of various sizes, a
circumscribed 'core' of small vessels on the left half of the cord (Fig. 4oc). The whole Li
segment was greatly demyelinated, especially on the side of the compression. Further
indentations and compression of the cord through large vessels were also seen in the
