Progressive Paraparesis Revealing a Spinal Schwannoma: A Case Report

Background: Spinal schwannomas are uncommon, benign tumors arising from the Schwann cells that form the nerve sheaths within the spinal canal. They constitute approximately 2% of all primary spinal tumors. We present the case of a young woman with a thoracic intradural schwannoma (representing a compressive myelopathy), who achieved complete neurological recovery following surgical resection. Case Report: A 30-year-old woman was admitted for progressive, asymmetric functional impairment of the lower limbs evolving over two months. Her symptoms had begun three months earlier with low back pain radiating to the left thigh, accompanied by paresthesia in the left foot. These paresthesias ascended progressively and became bilateral after one month. She reported no notable medical, surgical, or family history, and there was no history of spinal trauma. The neurological examination revealed signs of acute transverse myelitis at the T12 level and uro-fecal incontinence. Gadolinium-enhanced spinal Magnetic Resonance Imaging (MRI) demonstrated an oval-shaped, compressive intradural extramedullary mass extending from T12 to the mid-L1 level, which showed homogeneous contrast enhancement. Total surgical excision was performed six months after symptom onset, resulting in complete recovery of neurological deficits within ten days postoperatively. Histopathological analysis of the surgical specimen confirmed the diagnosis of schwannoma. Conclusion: Although rare, spinal schwannomas should be considered in the differential diagnosis of progressive myelopathy in young adults. Spinal MRI is the cornerstone of diagnostic evaluation. Complete surgical resection is the primary treatment and generally permits excellent neurological recovery.