Walsh & Hoyt: Tumors of the Spinal Cord

Neuro-ophthalmologic symptoms and signs caused by tumors of the spinal cord are exceedingly rare when the tumor is completely external to the foramen magnum. Spinal cord tumors are designated as extramedullary or intramedullary. Spinal cord tumors that occur in children are usually extramedullary and may be sarcomas, neurofibromas, and lipomas, whereas intramedullary tumors are usually gliomas. The symptoms and signs that arise in patients with tumors of the spinal cord are, to a large extent, dependent upon their exact location. The onset of symptoms is usually characterized by persistent pain, often associated with hyperesthesia caused by compression of one or more nerve roots. The pain is distributed in the dermatome that is supplied by the root being compressed. In children, pain is a frequent presenting sign, usually localizing to the bony segments overlying the tumor but occasionally referred to other, more remote regions supplied by the affected nerves and cord. Damage to the corticospinal tract produces spasticity and weakness of the extremities. Damage to the posterior columns produces loss of proprioception with subsequent ataxia and the appearance of Rombergs sign. Ultimately, anesthesia is produced below the level of the lesion, and there is difficulty controlling bowel and bladder function. The most common neuro-ophthalmic sign occurring in patients with tumors of the spinal cord is nystagmus.