J. Neurosurg: Spine / Volume 5 / July, 2006 J Neurosurg Spine 5:61–64, 2006 61 ODGKIN lymphomas primarily affecting the central nervous system are uncommon. Those causing spinal cord compression have been invariably ex- tradural. On further examinations, most of these reported lesions were found to extend contiguously into the ex- tradural compartment from adjacent sites. To our knowl- edge, we present the first case of a presumed primary in- tradural extraarachnoid Hodgkin lymphoma. Case Report History. In March 2000, this 42-year-old otherwise healthy man underwent examination for a 10-year history of neck pain. Initially, the pain was dull in intensity and not associated with any symptoms in the upper or lower extremities. In September 2000, the neck pain increased dramatically, becoming associated with numbness and tin- gling in the left thumb and index finger. By January 2001, the pain had started radiating into the region of the left scapula and triceps muscle. Pain and numbness in the tri- ceps and the ulnar aspect of the right forearm and hand be- came noticeable in March 2001. These symptoms quickly progressed to involve the right scapula and anterior chest wall. The pain worsened after alcohol consumption. The patient also reported weakness in the right forearm and hand at this time. Both legs remained symptom free. The patient had no other symptoms such as fevers, night sweats, weight loss, or fatigue, but he had experienced pruritus intermittently for 2 to 3 years. The remainder of his medical history was unremarkable. Examination. Physical examination revealed no evi- dence of lymphadenopathy, skin changes, or problems involving the cardiovascular and respiratory systems or the abdomen. The musculoskeletal examination demon- strated a decreased range of motion in the neck in all directions due to severe pain. There was no tenderness on percussion or palpation. On neurological assessment, mild weakness was noted in the triceps, wrist flexors, and in- trinsic muscles of both hands; the findings on the right side were more pronounced than on the left. He exhibited normal strength in the lower extremities and no evidence of altered tone or decreased bulk was noted in any limb. The reflexes were generally more brisk on the right side of the body than the left, and both lower extremities were thought to be hyperreflexive without sustained clonus. Primary intradural extraarachnoid Hodgkin lymphoma of the cervical spine Case report NAVRAJ S. HERAN, M.D., F.R.C.S.(C), RAYMUND L. YONG, M.D., MANRAJ S. HERAN, M.D., F.R.C.P.(C), STEVEN YIP , M.D., AND DAVID F AIRHOLM, M.D., F.R.C.S.(C) Division of Neurosurgery, Fraser Health Authority, New Westminster, British Columbia; and Division of Neurosurgery, Departments of Surgery and Radiology, and Division of Neuropathology, Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada  This 42-year-old man presented with an intradural extramedullary mass in his lower cervical spine. On imaging studies the lesion mimicked the appearance of a meningioma. At surgery, the mass was found to be an intradural extra- arachnoid tumor. An intraoperative pathological examination determined the lesion to be a Hodgkin lymphoma. The procedure was limited to biopsy sampling and the patient was treated further with adriamycin, bleomycin, vincristine, and dacarbazine chemotherapy, after which remission was demonstrated both clinically and on images. Analysis of a frozen section obtained during the procedure aided in the diagnosis of the tumor, thus preventing further resection and the potential neurological complications associated with more radical resection. To the authors’ knowledge this is the first reported case of a presumed primary intradural extraarachnoid Hodgkin lymphoma. KEY WORDS • spinal cord compression • intradural tumor • cervical spine • lymphoma • Hodgkin disease H Abbreviation used in this paper: CT = computed tomography. 9- 16016 6/5/06 3:50 PM Page 61