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MRI: Cord Compression
 

MRI: Cord Compression

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    MRI: Cord Compression MRI: Cord Compression Presentation Transcript

    • Presented by DR.ISHWARYA ANNAMALAI, M.D INTERNAL MEDICINE, I YEAR, PROF. DR.GOWRI SHANKAR UNIT.
    • CASE SUMMARY
      • 60 year old female patient rahamed beevi came wit the chief presenting complaints of
      • numbness both lower limbs-6 weeks,
      • weakness of both lower limbs-4 weeks,
      • urinary incontinence-2 weeks
      • Numbness-progressed from toes upto undersurface of breast.(all modalities of sensation lost).
      • 2 weeks later patient developed weakness both lower limbs with difficulty in walking.
      • CNS examination in brief :
      • Higher functions are normal.
      • Cranial nerves function – intact
      • Sensory-pain,temperature-lost below T6 level,
      • vibration sense & joint position sense
      • impaired below T6
      • Motor-both lower limbs hypertonic,
      • reflexes exaggerated,
      • b/l plantar extensor+
      • Cerebellar functions-normal.
      • Imaging studies done for the patient :
      • CONTRAST MRI of dorsal spine
      • CT spine.
      • CONTRAST MRI OF DORSAL SPINE
      • SAGGITAL AND CORONAL VIEW
      • CORONAL AND AXIAL VIEWS
    •  
    •  
      • Contrast MRI of dorsal spine shows:
      • T1 hyperintense area with hypointensities and T2 hyperintensity noted in D4,D5 vertebral bodies.
      • The lesion has both extradural and intradural extra medullary components causing cord compression.
      • The axial view shows widening of neural foramina On the rt side.
      • Multiple vertebral bodies show T2 hyperintense lesions.
      • DIFFERENTIAL DIAGNOSIS
      • 1. AGGRESSIVE HEMANGIOMA
      • 2.Plasmacytoma
      • 3.Aneurysmal bone cyst
      • 4.Non hodgkin lymphoma
      • RARE POSSIBILITIES :
      • 1.Neurofibroma
      • 2.Meningioma
      • 3.Schwannoma
      • 4.Osteosarcoma(telangiectatic)
      • 5.Osteoblastoma
      • 6.Malignant peripheral nerve sheath tumor
      • 7.angiolipoma
      • 8.melanoma
      • 9.rhabdomyo sarcoma
      • 10.chondrosarcoma
    • AGGRESSIVE HEMANGIOMA
    • PLASMACYTOMA
      • Features in favour:
      • site-vertebral body most common site
      • age-common after 55 yrs of age
      • similar MRI findings.
      • Features against this diagnosis:
      • More common in males.
      • More commonly involves posterior element of vertebral body
      • No involvement of contiguous vertebral body.
      • Vertebral body collapse common.
    • ANEURYSMAL BONE CYST
      • Features in favour:
      • Site-spine frequently involved.
      • Lumbosacral>thoracic>cervical
      • Arises in neural arch
      • 75 %-90% extend into vertebral body.
      • Features against this diagnosis:
      • Age-common in first 2 decades.
      • Occasionally T1w shows lobulated neural arch mass.
    • DIAGNOSTIC IMAGING METHOD IN AGGRESSIVE HEMANGIOMA
      • AXIAL BONE ALGORITHM CT
      • Hypodense well circumscribed with coarse vertical trabeculae-white polka dots
      • CONCLUSION:
      • Clinical features and imaging features favour the diagnosis of aggressive hemangioma
      • .
    • THANK YOU