Background Headache due to raised intracranial pressure is rarely caused by spinal lesions. We describe a patient with primary histiocytic sarcoma who presented with a new onset headache with features of raised intracranial pressure and subtle signs of cauda equina syndrome due to predominant lower spinal cord infiltration and minimal intracranial involvement. Case A previously well 54-year-old man presented with a 2-month history of new onset headache with features of raised intracranial pressure. Progression of lower limb weakness was delayed and mild with diagnostic delay resulting from the primary presentation with headache leading to an initial focus on cerebral pathology. Subsequent investigations revealed a previously unreported presentation of primary histiocytic sarcoma infiltrating the cauda equina causing raised intracranial pressure headache. Conclusion This case highlights the importance of a broad search in the investigation of new onset raised intracranial pressure headache, including imaging of the lower spinal cord. Primary histiocytic sarcoma should be considered in the differential diagnosis of this rare syndrome. Data sharing not applicable as no datasets generated and/or analysed for this study.

中文翻译：

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脊髓和软脑膜组织细胞肉瘤致新发头痛一例报告

背景 颅内压升高引起的头痛很少由脊柱病变引起。我们描述了一名原发性组织细胞肉瘤患者，由于主要的下段脊髓浸润和少量颅内受累，患者出现新发头痛，表现为颅内压升高和马尾神经综合征的细微征象。病例 54 岁男性，既往良好，因新发头痛 2 个月就诊，表现为颅内压升高。下肢无力的进展延迟且轻微，诊断延迟是由于主要表现为头痛导致最初关注脑病理学。随后的调查显示，以前未报道的原发性组织细胞肉瘤浸润马尾神经，导致颅内压升高性头痛。结论 该病例强调了在新发颅内压升高性头痛的调查中进行广泛搜索的重要性，包括下脊髓成像。在这种罕见综合征的鉴别诊断中应考虑原发性组织细胞肉瘤。数据共享不适用，因为没有为本研究生成和/或分析的数据集。