Spontaneous subarachnoid hemorrhage in intradural tumors of the lumbar sac; a clinical syndrome.

T HIS iS a neurosurgical postulate in which there is an abrupt onset of intractable sciatica, a concomitant violent headache and the presence of a liberal amount of fresh blood in the spinal fluid. The total experience on which this study is based is perhaps insufficient for finality. The clinical parallelism in these cases, however, is so striking as to suggest that with a few additional contributions one may confirm the clinical characterization of certain tumors within the dura of the lumbar limits of the spinal canal. The diagnosis of these tumors is completely dependent on contrast myelographic studies of this spinal area. Unless these investigations are inaugurated early, intermittent attacks of radicular distress and cephalalgia can be expected. With present-day attention centered on the "ruptured intervertebral disk" in accounting for lumbago-sciatica handicaps, and the enthusiasm for cerebral angiography in spontaneous subarachnoid hemorrhage, it seems apropos that attention be given this possible syndrome for certain lumbar intradural tumors. The first case of meningeal hemorrhage caused by a tumor of the cauda equina was reported by Andr6-Thomas et al. 2 in 1930. The only other ease in the literature was chronicled by Abbott I in 1939. I t is of passing historical interest, as pointed out by Andr6-Thomas, that Vigneras was in error in his interpretation that "the existence of a yellow fluid on spinal puncture" in 3 of his cases indicated meningeal hemorrhage caused by medullary tumors of the spinal cord. Andr6-Thomas likewise directed similar criticism to Elsberg's report of bleeding tendencies in spinal cord tumors, for Elsberg also thought the xanthochromic spinal fluid was of hemorrhagic origin. So it stands that Andr6-Thomas recorded the first experience of a true recurrent spinal hemorrhage associated with a verified tumor of the cauda equina. The fluid withdrawn in his ease was "the color of p o r t w i n e . . , withdrawn easily and a b u n d a n t l y . . , when centrifuged the fluid remained colored showing an extensive hemolysis." Cisternal puncture was performed on Andr6-Thomas' patient on the day following a lumbar puncture, and the "eerebrospinal fluid withdrawn was slightly colored but infinitely less bloody than that from the subarachnoid lumbar spaces." Abbott's ease