Thoracic Intramedullary Venous Haemangioma Presenting with Progressive Myelopathy: A Case Report

Abstract

Introduction: Hemangiomas are vascular tumors that are not malignant and arise from the aberrant growth of blood vessels. Primary CNS tumors can occur in any part of the central nervous system, including the brain and spinal cord Aim: The aim of this case report is to emphasize the diagnostic challenge of intramedullary venous hemangiomas, which often mimic common intramedullary tumors, and to highlight the role of early surgical intervention with histopathological confirmation and rehabilitation in achieving favorable neurological outcomes in patients with rare spinal vascular lesions. Case Presentation: A 21-year-old male who presented with progressive bilateral lower limb weakness of one month’s duration. MRI of the spine revealed an encapsulated intramedullary lesion at the D4–D5 vertebral level with contrast enhancement and areas of hemorrhage, initially suggestive of a spinal ependymoma. The patient underwent D3–D6 laminoplasty with near-total excision of the lesion under intraoperative neuromonitoring. Histopathological analysis confirmed the diagnosis of an intramedullary venous hemangioma. Postoperatively, the patient received structured neurological rehabilitation and showed gradual improvement in motor function with no complications. Discussion: Intramedullary venous Hemangiomas are rare benign vascular lesions of the spinal cord, often misdiagnosed as more common intramedullary tumors such as ependymomas or astrocytomas due to overlapping clinical and radiological features. Surgical resection is the only effective treatment, though challenging, requiring early intervention to prevent irreversible neurological deficits. Conclusion: This case highlights the importance of considering vascular lesions such as intramedullary venous hemangiomas in the differential diagnosis of spinal cord tumors. MRI remains a vital diagnostic tool, but histopathological confirmation is essential. Early surgical intervention with neuromonitoring, followed by multidisciplinary rehabilitation, can lead to favorable neurological outcomes even in rare spinal cord pathologies.