Abstract
Neurological deterioration sometimes follows removal of cerebro-spinal fluid by lumbar puncture below a spinal block caused by a tumour. Experience has shown that similar impaction of a spinal intradural tumour may occur following the draining of hydrocephalus. We have used the term "upward spinal coning " to describe this and report four cases in which impaction of an intradural metastasis occurred when the obstructive hydrocephalus caused by the primary intracranial tumour was relieved. The possible mechanisms are discussed. Awareness of the syndrome is important for early diagnosis and treatment and motor power should be assessed regularly following the relief of hydrocephalus caused by a tumour known to seed in the spinal subarachnoid space.
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- Bryan P. CSF seeding of intra-cranial tumours: a study of 96 cases. Clin Radiol. 1974 Jul;25(3):355–360. doi: 10.1016/s0009-9260(74)80168-6. [DOI] [PubMed] [Google Scholar]
- Cuneo R. A., Caronna J. J., Pitts L., Townsend J., Winestock D. P. Upward transtentorial herniation: seven cases and a literature review. Arch Neurol. 1979 Oct;36(10):618–623. doi: 10.1001/archneur.1979.00500460052006. [DOI] [PubMed] [Google Scholar]
- Eisenberg H. M., Sarwar M. Ventriculographic features of ascending transtentorial herniation. Acta Neurochir (Wien) 1978;42(3-4):225–228. doi: 10.1007/BF01405337. [DOI] [PubMed] [Google Scholar]
- Emery J. L. Kinking of the medulla in children with acute cerebral oedema and hydrocephalus and its relationship to the dentate ligaments. J Neurol Neurosurg Psychiatry. 1967 Jun;30(3):267–275. doi: 10.1136/jnnp.30.3.267. [DOI] [PMC free article] [PubMed] [Google Scholar]
- FOWLER F. D., ALEXANDER E., Jr, DAVIS C. H., Jr Pinealoma with metastases in the central nervous system; a rationale of treatment. J Neurosurg. 1956 May;13(3):271–288. doi: 10.3171/jns.1956.13.3.0271. [DOI] [PubMed] [Google Scholar]
- HOWELL D. A. Upper brain-stem compression and foraminal impaction with intracranial space-occupying lesions and brain swelling. Brain. 1959 Dec;82:525–550. doi: 10.1093/brain/82.4.525. [DOI] [PubMed] [Google Scholar]
- JOHNSON R. T., YATES P. O. Clinicopathological aspects of pressure changes at the tentorium. Acta radiol. 1956 Jul-Aug;46(1-2):242–249. doi: 10.3109/00016925609170833. [DOI] [PubMed] [Google Scholar]
- Jooma R., Kendall B. E. Diagnosis and management of pineal tumors. J Neurosurg. 1983 May;58(5):654–665. doi: 10.3171/jns.1983.58.5.0654. [DOI] [PubMed] [Google Scholar]
- Kaufmann G. E., Clark K. Continuous simultaneous monitoring of intraventricular and cervical subarachnoid cerebrospinal fluid pressure to indicate development of cerebral or tonsillar herniation. J Neurosurg. 1970 Aug;33(2):145–150. doi: 10.3171/jns.1970.33.2.0145. [DOI] [PubMed] [Google Scholar]
- REID J. D. Effects of flexion-extension movements of the head and spine upon the spinal cord and nerve roots. J Neurol Neurosurg Psychiatry. 1960 Aug;23:214–221. doi: 10.1136/jnnp.23.3.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Renaudin J. W., DiTullio M. V., Brown W. J. Seeding of intracranial ependymomas in children. Childs Brain. 1979;5(4):408–412. doi: 10.1159/000119835. [DOI] [PubMed] [Google Scholar]
- STRANG R. R. Intraspinal metastases from medulloblastomas of the posterior fossa. Med J Aust. 1962 Sep 29;49(2):507–510. [PubMed] [Google Scholar]
- WOOD E. H., TAVERAS J. M., POOL J. L. Myelographic demonstration of spinal cord metastases from primary brain tumors. Am J Roentgenol Radium Ther Nucl Med. 1953 Feb;69(2):221–230. [PubMed] [Google Scholar]