eMedicine Specialties > Dermatology > Diseases of the Vessels

Cobb Syndrome: Differential Diagnoses & Workup

Author: Christopher Norwood, MD, MS, Assistant Clinical Professor, Department of Dermatology, University of Connecticut Health Center
Coauthor(s): Stephen J Krivda, MD, Assistant Professor of Dermatology, Uniformed Services University of the Health Sciences; Chief of the Integrated Department of Dermatology, Chief of Dermatology Service, Director of Dermatopathology, Staff Dermatopathologist, Walter Reed Army Medical Center; Head, Department of Dermatology, Staff Dermatologist and Dermatopathologist, National Naval Medical
Contributor Information and Disclosures

Updated: Dec 12, 2008

Differential Diagnoses

Angiokeratoma Corporis Diffusum (Fabry Syndrome)
Herpes Zoster
Infantile Hemangioma

Workup

Imaging Studies

  • MRI, radiography, and angiography all may be ordered in consultation with a neurologist and radiologist.
  • MRI probably is the most effective study, though CT, plain radiography, and angiography all provide useful information.
  • Criteria that are significant in the evaluation of cord compression are the following:
    • Localization of a lesion between T3 and T9
    • Involvement of the entire vertebral body
    • Extension to the neural arch
    • An expanded cortex with indistinct margins
    • Irregular honeycomb pattern
    • A soft tissue mass
  • Prior to the advent of CT and MRI, the classic finding on plain film was vertical striations of the vertebral body.

Procedures

  • Perform lumbar puncture to rule out infectious etiology.

More on Cobb Syndrome

Overview: Cobb Syndrome
Differential Diagnoses & Workup: Cobb Syndrome
Treatment & Medication: Cobb Syndrome
Follow-up: Cobb Syndrome
Multimedia: Cobb Syndrome
References

References

  1. Cobb S. Haemangioma of the spinal cord associated with skin naevi of the same metamere. Annals Surgery. 1915;62:641-9.

  2. Clinton TS, Cooke LM, Graham BS. Cobb syndrome associated with a verrucous (angiokeratomalike) vascular malformation. Cutis. Apr 2003;71(4):283-7. [Medline].

  3. Shim JH, Lee DW, Cho BK. A case of Cobb syndrome associated with lymphangioma circumscriptum. Dermatology. 1996;193(1):45-7. [Medline].

  4. Wirth FP, Post KD, Di Chiro G. Foix-Alajouanine disease. Spontaneous thrombosis of a spinal cord arteriovenous malformation: a case report. Neurology. 1970;20:1114-18.

  5. Krings T, Geibprasert S, Luo CB, Bhattacharya JJ, Alvarez H, Lasjaunias P. Segmental Neurovascular syndromes in children. Neuroimaging Clin N Am. May 2007;17:245-58. [Medline].

  6. Miyatake S, Kikuchi H, Koide T, Yamagata S, Nagata I, Minami S, et al. Cobb's syndrome and its treatment with embolization. Case report. J Neurosurg. Mar 1990;72(3):497-9. [Medline].

  7. Soeda A, Sakai N, Iihara K, Nagata I. Cobb syndrome in an infant: treatment with endovascular embolization and corticosteroid therapy: case report. Neurosurgery. Mar 2003;52(3):711-5; discussion 714-5. [Medline].

  8. Aminoff MJ, Logue V. Clinical features of spinal vascular malformations. Brain. Mar 1974;97(1):197-210. [Medline].

  9. Aminoff MJ, Logue V. The prognosis of patients with spinal vascular malformations. Brain. Mar 1974;97(1):211-8. [Medline].

  10. Brant AJ, James HE, Tung H. Cutaneomeningospinal angiomatosis (Cobb syndrome) with tethered cord. Pediatr Neurosurg. Feb 1999;30(2):93-5. [Medline].

  11. Doppman JL, Wirth FP Jr, Di Chiro G, Ommaya AK. Value of cutaneous angiomas in the arteriographic localization of spinal-cord arteriovenous malformations. N Engl J Med. Dec 25 1969;281(26):1440-4. [Medline].

  12. Jessen RT, Thompson S, Smith EB. Cobb syndrome. Arch Dermatol. Nov 1977;113(11):1587-90. [Medline].

  13. Kaplan P, Hollenberg RD, Fraser FC. A spinal arteriovenous malformation with hereditary cutaneous hemangiomas. Am J Dis Child. Dec 1976;130(12):1329-31. [Medline].

  14. Karshner R, Rand C, Reeves D. Epidural hemangioma associated with hemangioma of the vertebrae. Report of a case. Arch Surgery. 1939;39:942-51.

  15. Laredo JD, Reizine D, Bard M, Merland JJ. Vertebral hemangiomas: radiologic evaluation. Radiology. Oct 1986;161(1):183-9. [Medline].

  16. Mercer RD, Rothner AD, Cook SA, Alfidi RJ. The Cobb syndrome: association with hereditary cutaneous hemangiomas. Cleve Clin Q. 1978;45(2):237-40. [Medline].

  17. Wakabayashi Y, Isono M, Shimomura T, Tajima A, Terashi H, Asada Y, et al. Neurocutaneous vascular hamartomas mimicking Cobb syndrome. Case report. J Neurosurg. Jul 2000;93(1 Suppl):133-6. [Medline].

Further Reading

Keywords

cutaneomeningospinal angiomatosis

Contributor Information and Disclosures

Author

Christopher Norwood, MD, MS, Assistant Clinical Professor, Department of Dermatology, University of Connecticut Health Center
Christopher Norwood, MD, MS is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Stephen J Krivda, MD, Assistant Professor of Dermatology, Uniformed Services University of the Health Sciences; Chief of the Integrated Department of Dermatology, Chief of Dermatology Service, Director of Dermatopathology, Staff Dermatopathologist, Walter Reed Army Medical Center; Head, Department of Dermatology, Staff Dermatologist and Dermatopathologist, National Naval Medical
Stephen J Krivda, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Abby S Van Voorhees, MD, Assistant Professor, Director of Psoriasis Services and Phototherapy Units, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania
Abby S Van Voorhees, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, National Psoriasis Foundation, Phi Beta Kappa, Sigma Xi, and Women's Dermatologic Society
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Genentech Honoraria Consulting; Incyte Grant/research funds Other; Warner Chilcott Honoraria Consulting; Merck Salary Management position; Abbott  Speaking and teaching

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Rosalie Elenitsas, MD, Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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