Spinal cord tumor - Simulated by an ischemic infarction of the conus and epiconus medullaris. Report of two cases and review of literature

Two cases (a 80-year-old and a 66-year-old male) with progressive parapares is and disturbances of bladder and bowel function were demonstrated. The ma gnetic resonance imaging in both cases showed what appeared to be a tumour in the conus/epiconus medullaris. After laminectomie and median myelotomie a biopsy was performed. The histological changes were consistent with ische mic infarction of the conus medullaris. In the case of the 80-year-old pati ent the neurologic deficits improved. In the other case the deficits remain ed unchanged postoperatively. Review of the literature showed that only four similar cases were reported upon. Especially in elderly patients with tumor like lesions in conus/epico nus medullaris infarction should be taken into consideration. The search fo r on infrarenal aortic aneurysm and a dura compressing disc herniation in t he upper thoracal segments may be helpful in the diagnosis. A conservative treatment may he the first choice. Surgery is only indicated in cases with progressive neurologic deficits.