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Fig. 29.6. Intraoperative view of an ependymoma a before and b after resection.

Fig. 29.6. Intraoperative view of an ependymoma a before and b after resection.

a b which case an intramedullary tumor is the more likely cause, or it may have a radicular distribution, which is more common in intradural extramedullary lesions [15]. Young children may even present with abdominal pain as a nonspecific symptom that makes finding the correct diagnosis particularly difficult. Pain is characteristically more severe in the horizontal position, thus causing nighttime pain.

Motor function appears to be affected early [5,16] in younger children: this may manifest as motor regression, i.e. refusal to stand or crawl after having learned to walk, or as gait abnormality. Young adults present with lower-extremity weakness, clumsiness or frequent falls. On examination, the majority of these patients show some mild to moderate motor deficit, as well as upper motor neuron-type findings, such as spasticity, hyperreflexia and clonus.

About one-third of the patients have some degree of spinal deformity, most of them with tumors in the thoracic region. Paraspinal pain is common in this group and attributed to the scoliosis. Torticollis was seen in about one-fifth of the pediatric patients.

Sensory symptoms, mostly dysesthesias, described as unpleasant hot or cold sensations, are also found in about 20% of the patients. In glial tumors, as opposed to ependymomas, the

Fig. 29.7. Myxopapillary ependymoma of the on a MRI HMHHRHi^ 1 ^«Ld

Fig. 29.7. Myxopapillary ependymoma of the on a MRI HMHHRHi^ 1 ^«Ld

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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