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  • 1. Presented by DR.ISHWARYA ANNAMALAI, M.D INTERNAL MEDICINE, I YEAR, PROF. DR.GOWRI SHANKAR UNIT.
  • 2. 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.
  • 3.
    • 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.
  • 4.
    • Imaging studies done for the patient :
    • CONTRAST MRI of dorsal spine
    • CT spine.
  • 5.
    • CONTRAST MRI OF DORSAL SPINE
    • SAGGITAL AND CORONAL VIEW
  • 6.
    • CORONAL AND AXIAL VIEWS
  • 7.  
  • 8.  
  • 9.
    • 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.
  • 10.
    • DIFFERENTIAL DIAGNOSIS
    • 1. AGGRESSIVE HEMANGIOMA
    • 2.Plasmacytoma
    • 3.Aneurysmal bone cyst
    • 4.Non hodgkin lymphoma
    • RARE POSSIBILITIES :
    • 1.Neurofibroma
    • 2.Meningioma
    • 3.Schwannoma
  • 11.
    • 4.Osteosarcoma(telangiectatic)
    • 5.Osteoblastoma
    • 6.Malignant peripheral nerve sheath tumor
    • 7.angiolipoma
    • 8.melanoma
    • 9.rhabdomyo sarcoma
    • 10.chondrosarcoma
  • 12. AGGRESSIVE HEMANGIOMA
  • 13. 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.
  • 14. 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.
  • 15. 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
    • .
  • 16. THANK YOU