Pure epidural cavernous hemangiomas of the spinal canal are extremely rare. We describe a case of lumbar epidural hemangioma suspected as a lumbar radiculopathy in a 78-year-old man who presented with a 1-month history of the low back pain and right lower extremity pain. An electrodiagnostic study demonstrated right L4 radiculopathy. Noncontrast magnetic resonance image (MRI) showed a nodular lesion suggestive of a sequestered disc with compression of right L4 root, most likely. Contrast MRI revealed an oval enhancing nodular lesion, 1.4×0.5 cm in size, indicative of a hemangioma in right anterior epidural space at L4 level. He underwent an excisional biopsy. The pathological diagnosis was cavernous hemangioma. His symptoms resolved after the operation. Spinal epidural cavernous hemangioma should be considered as a cause of a lumbar radiculopathy. (J Korean Acad Rehab Med 2010; 34: 238-241)

Cavernous hemangiomas occur throughout the central nervous system. Although they are most commonly found in the brain, the intraspinal lesion accounts for approximately 5% of all adult intramedullary lesions. Widespread use of MR imaging have led to an increase in the reported cases of intramedullary cavernous hamangiomas. Spinal intramedullary cavernomas are positioned in a particularly precarious location, and are more likely to cause clinically significant findings than cranial cavernomas. It is important to recognize cavernomas as a surgically manageable cause of myelopathy. Generally, surgery cannot cure the chronic myelopathy from cavernoma but can halt it's progression. These facts emphasize the need for early diagnosis. In our two cases, they developed initially low back pain and sensory changes of both legs and subsequently paraplegia. We report two cases of intramedullary cavernous hemangioma with the review of literatures. (J Korean Acad Rehab Med 2002; 26: 815-818)