We report the case of a 47-year-old woman who came to the emergency department of our hospital with sudden onset of severe low back pain with difficulty walking, which progressed rapidly to a paraplegia.
Personal history included allergy to penicillin and arterial hypertension classified as idiopathic, which was diagnosed seven years ago and treated with enalapril-hydrochlorothiazide (20-12.5mg/24h).
In the anamnesis, the patient reported sudden onset of pain, which came to wake up at night.
The pain radiated to both lower extremities and hindered walking.
The patient denied any previous trauma.
Initial physical examination revealed a motor balance of 3/5 in psoas and quadriceps with 0/5 in plantar flexion-extension.
Anesthesia was also detected in the right lower extremity with thermoalgesic hypoesthesia in the left lower extremity along with perineal anesthesia, bladder balloon and fecal incontinence.
The motor balance in the upper limbs was 5/5.
The patient had no fever or signs of meningeal irritation.
An urgent computed tomography (CT) of the lumbar region was requested, which showed no alteration.
A magnetic resonance imaging (MRI) of the lumbar spine showed the presence of an intradural lesion occupying the entire dural sac at L2-L3-L4 levels with a satellite lesion associated with the sacrum.
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With the initial clinical and radiological suspicion of malignancy an emergency surgery was performed, performing a laminectomy and pedicle fixation L2-L3-L4.
When dural opening was performed, we observed an encapsulated violaceous red tumour displacing lateral nerve roots.
Median microsurgery was easily dissected the tumor from adjacent roots and completely removed in a single piece.
The lesion was adhered only to terminal illness.
The postoperative period was uneventful, with progressive recovery of motor function and beginning of sphincter control.
Pathological diagnosis of melanoma was established. Catechol levels were measured in blood and urine, all of which were normal.
The patient was discharged to a rehabilitation center to complete recovery.
