Intramedullary conus medullaris cavernous malformation: A narrative review with a case illustration

Background Intramedullary spinal cord cavernous malformations (ISCCMs) are rare vascular lesions characterized by sinusoidal vascular channels without intervening neural tissue. They often present with nonspecific symptoms or acute neurological decline due to hemorrhage. Magnetic resonance imaging (MRI) is the diagnostic modality of choice, with a hypointense hemosiderin rim on T2-weighted imaging. Case description We report the case of a 36-year-old woman who presented with acute-onset bilateral limb numbness, limping gait, and sphincter dysfunction progressing over a period of 24 h. MRI revealed a hemorrhagic intramedullary lesion at the conus medullaris consistent with a cavernous malformation. The patient underwent urgent T12-L1 laminectomy with microsurgical excision of the intradural intramedullary lesion. Postoperatively, the patient achieved complete neurological recovery, with her Modified Rankin Scale (mRS) improving from 4 preoperatively to 0 at two weeks, and McCormick grade from III to I. Conclusion Early diagnosis and timely surgical intervention in symptomatic ISCCMs can result in favorable functional recovery. This report highlights conus medullaris–specific clinical features, acute hemorrhagic presentation, and microsurgical decision-making in intramedullary cavernous malformations, supported by a targeted review of the literature.