C’liniccrl Nwrolog~ und Nw~~surger~, 94 (1992) 69-72 0 1992 Elsevier Science Publishers B.V. All rights reserved 0303-8467/92/S 05.00 69 CLINEU 00178 Case report Spinal subarachnoid hemorrhage due to a filum terminale ependymoma P. Admiraal”, G.J. Hazenberga, P.R. Algrab, W. Kamphorst” and J.G. Wolbersd “ Departments qf “ Neurology, ‘Rudiology, ‘Pathology and ‘Neurosurgery, Free University Hospitul, Amsterdam, The Nether1and.s (Received 24 September, 1991) (Revised, received I I December. 1991) (Accepted 16 December, 1991) Key ,~orcls; Ependymoma; Filum terminale; subarachnoid hemorrhage: MRI Summary We present a case of spinal subarachnoid hemorrhage due to an ependymoma of the filum terminale in a 23-year-old male. Clinical signs indicating a spinal origin of the subarachnoid hemorrhage are discussed. Subarachnoid hemor- rhages are only rarely caused by an intraspinal tumor, most of which are located in the cauda equina. Our findings in this case proved the value of MRI examination in tumors of the cauda equina. Introduction Tumors of the cauda equina are uncommon, repre- senting 1% of the central nervous system tumors [l zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDC 11. The occurrence of ependymomas in the filum terminale varies according to the different published series [l-5]. Of the 100 filum terminale tumors reported by Ntir- Strom, 89 were ependymomas [6]. The symptomatology often lacks characteristic features, because it can mimic more common sciatic syndromes. Only on rare occas- sions does an intraspinal tumor cause a subarachnoid hemorrhage. Demonstrating a clinical picture, com- pletely different to that of an intracranial subarachnoid hemorrhage [7,8.13]. Since the original report by And+ Thomas in 1930, 54 cases of subarachnoid hemorrhage caused by a filum terminale tumor have been reported in the literature [7- lo]. Corrrspondmce IO: P. Admiradl, Department of Neurology, Free University Hospital, De Boelelaan 1117. 1081 HV Amsterdam, The Netherlands Case report A 23-year-old male carpenter was referred to our hos- pital because of otitis media. In the course of a number of years he had been operated 4 times for a benign cholesteatoma in the right middle ear. On admission the ENT specialist found no signs of otitis media or cholesteatoma. Two weeks earlier he had done some heavy work with much lifting. After this he suffered from headache. had fever and general malaise. Also he experi- enced backache and much pain in both upper legs, which typically became worse upon biking. The bladder and bowel functions were normal. On examination the body temperature was 38.5”C, with normal pulse and blood pressure. Conciousness was clear, slight nuchal rigidity was present, in supine position, on lifting his head. Fun- doscopic examination of the eyes showed no abnormali- ties. Straight-leg-raising tests were positive bilaterally at 10”. Strength, sensation, coordination and reflex re- sponses were normal, and routine laboratory tests of blood and urine showed no abnormalities. Lumbar puncture at L4iL5 level yielded blood-stained cerebro- spinal fluid in 4 consecutive tubes. A CT scan of the