080311 INTRAMEDULLARY SPINAL CORD TUMOR, SUSPICIOUS ASTROCYTOMA

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080311 INTRAMEDULLARY SPINAL CORD TUMOR, SUSPICIOUS ASTROCYTOMA

Contributed by: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.

Patient: 15 year old male

History: Progressive right shoulder and posterior neck stiffness and right arm weakness for 3 months.
Increased deep tendon reflexes(DTR) in 4 limbs (+), intermittent fever recently (+).

Images:

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Fig. 1: T2WI


Fig. 2: Gd enhancement

Findings:

MRI of brain and cervical spine with T1 weighted echo train spin
echo, T2 weighted echo train spin echo, fluid-attenuated
inversion recovery echo train spin echo, MR diffusion imaging,
time-of-flight MR angiogarphy with 3D maximum-intensity
projection reconstruction, and with intravenous gadolinium-
enhancement:

1. A long T1 and T2 lesion, about 6.1cm in greatest dimension,
   with heterogeneous ring-like contrast enhancement within
   marked expanded cervical spinal cord (red arrows in figures),
   at the level from foramen magnum to C2/3 junction, possibly
   due to intramedullary spinal cord tumor such as astrocytoma.
2. Presence of long T1 and T2 cystic lesions without contrast
   enhancement in medulla oblongata (yellow arrows in figures),
   just above the tumor, and in C3 spinal cord (green arrows),
   just below the tumor, in favor of polar cysts.
3. Suspicious obstruction of foramen of Magendie from external
   compression by the polar cyst in medulla oblongata.
   Patency of bilateral foramen of Luschka.

Impression:
1. Intramedullary spinal cord tumor, C1-C2, nature to be determined.
Polar cysts in medulla oblongata and C3.

Diagnosis: Intramedullary spinal cord tumor, suspicious astrocytoma

Discussion: <Progress Note>
The patient received laminectomy and drainage of the medulla oblongata polar cyst for decompression.
And subsequence radiotherapy was arranged.

Comments:

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Additional Details:

Case Number: 13905565Last Updated: 03-20-2008
Anatomy: Spine and Peripheral Nervous System Pathology: Neoplasm
Modality: MRAccess Level: Readable by all users
Keywords: intramedullary, spinal cord, astrocytoma, polarACR: 341.369

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