JingJuan Min M.D.              St. Luke’s Medical Center
Meningismus caused by spinal subarachnoid hemorrhage due to clear cell meningioma 
         
 

Subarachnoid hemorrhage (SAH) is a catastrophic condition most commonly due to cerebral saccular aneurysm and arteriovenous malformation. We present a case of spinal SAH caused by a clear cell meningioma at L2 level.

A 18-year-old male presented clinically with symptoms mimicking meningitis or SAH with severe headache, neck stiffness, leukocytosis and low grade fever. The coexisting symptoms of low back pain and vague lower extremity paresthesia prompted MRI of spine, which disclosed an intradural extra-axial spinal tumor at L2 level with evidence of severe SAH. This finding deferred a lumbar puncture and cerebral arteriogram. Patient subsequently sent through decompressive laminectomy and tumor excision. Histological studies revealed a benign clear cell meningioma.

SAH is rarely caused by an intraspinal tumor. Spinal SAH should come under differential diagnosis when patient was suspected having SAH or meningitis, esp. with symptoms of back pain and only low grade fever. Our finding proved the value of MRI examination in tumor of the spine in the pertinent clinical setting.