This document provides an overview of approaches to spinal tumors. It begins by discussing how location, clinical presentation, age and gender are important for differential diagnosis. Spinal tumors are classified as intramedullary, intradural extramedullary, or extradural. The approach involves first examining the spinal cord and CSF spaces for expansion or compression. Common intramedullary tumors discussed include ependymomas, astrocytomas, gangliogliomas, and hemangioblastomas. Intradural extramedullary tumors include meningiomas, nerve sheath tumors, and myxopapillary ependymomas. Imaging features that help characterize different tumors are also summarized.
Intramedullary spinal cord tumor is the rare condition demanding high index of suspicion in diagnosis and high yield surgical expertise to produce good outcome.
The benign brain tumours may be intimately associated
with, and surrounded by, the adjacent
brain, but the tumour cells do not invade the underlying
brain. This is in contradistinction to the
gliomas, which are intrinsic brain tumours actively
invading the adjacent brain. This chapter
will discuss the more common benign brain tumours—
meningioma and acoustic neuroma—
and give a brief description of the less common
tumours: haemangioblastoma, epidermoid and
dermoid cysts and colloid cysts
Rhabdomyosarcoma is a malignant mesenchymal tumor with features of skeletal muscle. It is the most common childhood and adolescent soft tissue sarcoma, frequently involving the head and neck in children.
Intramedullary spinal cord tumor is the rare condition demanding high index of suspicion in diagnosis and high yield surgical expertise to produce good outcome.
The benign brain tumours may be intimately associated
with, and surrounded by, the adjacent
brain, but the tumour cells do not invade the underlying
brain. This is in contradistinction to the
gliomas, which are intrinsic brain tumours actively
invading the adjacent brain. This chapter
will discuss the more common benign brain tumours—
meningioma and acoustic neuroma—
and give a brief description of the less common
tumours: haemangioblastoma, epidermoid and
dermoid cysts and colloid cysts
Rhabdomyosarcoma is a malignant mesenchymal tumor with features of skeletal muscle. It is the most common childhood and adolescent soft tissue sarcoma, frequently involving the head and neck in children.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
IMAGING OF SPINAL TUMORS
1. APPROACH TO SPINAL TUMORS
MODERATOR: DR. JHONY PRASAD
Assistant professor
PRESENTER : Dr. AASRITHA K
2. In establishing the differential diagnosis for a spinal
lesion, location is the most important feature, along
with the clinical presentation age and gender.
3. CLASSIFICATION OF LESIONS
Spinal tumors are subdivided according to
their point of origin:
Intramedullary
Extramedullary – Intradural
Extradural
4.
5. APPROACH
STEP 1 : LOOK AT CORD
EXPANDED
INTRAMEDULLARY
NOT EXPANDED/ COMPRESSED
STEP 2 : LOOK AT CSF
(subarachnoid space)
EXPANDED NOT EXPANDED
INTRADURAL
EXTRAMEDULLARY
EXTRADURAL
10. Intramedullary tumors
Rare tumors, accounting for about 4-10% of all
central nervous system tumors.
Cause expansion of cord.
Intramedullary tumors include
1. Gliomas (ependymomas, astrocytomas and
gangliogliomas) and
2. Nonglial tumors (such as
hemangioblastomas, lymphoma and
metastases).
11. Ependymomas
MC intramedullary neoplasm in adults
Usually occurs in the cervical region
Cause symmetrical cord expansion
Slightly more common in women of 40to 50 years of
age.
Increased incidence inpatients with NF-2.
12. characterized by slow growth and compress rather
than infiltrate adjacent spinal cord tissue, generally
yielding a cleavage plane that aids in surgical
resection.
These lesions arise from ependymal cells that line the
central canal and therefore tend to be central in
location with respect to the spinal cord.
Almost all spinal cord ependymomas are low grade.
13. Imaging
On MRI, iso- to hypointense on T1WI and
hyperintense on T2WI.
Ependymomas tend to produce symmetric spinal
cord expansion and usually have solid and cystic
components.
NON TUMORAL CYSTS TUMORAL CYSTS
Occur @ poles Located within the solid
tumor
Dilation of central canal Lined by tumor cells
Do not enhance Peripheral enhancement
Resolve once tumor is
resected
Should be resected with the
tumor
14. • The solid components of ependymomas usually enhance
avidly, although the degree of enhancement may vary
considerably.
• In addition, ependymomas can hemorrhage, resulting in
the “cap sign” a hypointense rim at the
periphery of the tumor on T2-weighted imaging that is
related to hemosiderin deposition from prior hemorrhage.
• Clear tumor margins, more uniform enhancement
and central location can help differentiate
ependymomas from other intramedullary spinal cord
tumors
• Metastases in the subarachnoid space.
15.
16. ASTROCYTOMAS
They are the most common childhood intramedullary
neoplasms of the spinal cord and are second only to
ependymomas in adults.
In contradiction to ependymomas, astrocytomas
are located eccentrically within the spinal cord.
However, spinal cord astrocytomas tend to infiltrate the
cord and are, therefore, difficult to resect completely and
have worse prognosis.
17. Imaging
The cervicomedullary junction and the cervico-thoracic cord.
On MR imaging, pilocytic astrocytomas are characterized by
enlargement of the spinal cord within a widened spinal canal.
They frequently involve a large portion of the cord, spanning
multiple vertebral levels in length.
Tumors can show areas of necrotic-cystic degeneration, can have a
cyst with mural nodule appearance or can be solid.
solid components are iso- to hypointense on T1WIs and
hyperintense on T2WI.
18. The pattern of enhancement can be focal nodular,
patchy or inhomogeneous, diffuse enhancement and
does not define tumor margins.
Nonenhancing intramedullary astrocytomas are not
uncommon.
Like ependymomas, they can have intratumoral or polar
cysts but do not tend to hemorrhage and, therefore, do
not usually display a cap sign.
Associated with NF1.
19. EPENDYMOMA ASTROCYTOMA
AGE Adult Pediatric
LOCATION Central Eccentric
MORPHOLOGY Well circumscribed Ill defined
HEMORRHAGE common uncommon
ENHANCEMENT Focal intense, homogenous Patchy irregular
inhomogenous
CONUS OR FILUM yes atypical
ASSOCIATIONS NF2 NF1
ROLE OF DTI Displacement of central
tracts peripherally
Interruption or disruption of
fibres
20.
21. SUBEPENDYMOMA
Rare tumors
WHO grade 1
fusiform dilatation of the spinal cord with well-defined
borders.
Unlike other ependymomas, they are eccentrically
located.
Enhancement has sharply defined margins (50
% of cases), whereas those that do not enhance
have diffuse symmetric spinal cord enlargement.
23. Ganglioglioma
Gangliogliomas are the second most common intramedullary
tumor in the pediatric age group and mostly affect children
between 1 and 5 years of age, as do pilocytic astrocytomas.
Cervical spine > thoracic region.
These tumors tend to have a low malignant potential, slow
growth, but they have a significant propensity for local
recurrence.
Gangliogliomas tend to be extensive on presentation, occupying
an average length of 8 vertebral segments, compared with
ependymomas and astrocytomas, which average 4 vertebral
segments in length.
24. Imaging
Calcification is probably the single most suggestive
feature of gangliogliomas.
In the absence of gross calcification, the MR imaging appearance
of gangliogliomas is nonspecific and does not allow differentiation
from astrocytomas.
Solid portions have mixed iso-hypointensity on T1WI and
heterogeneous iso- hyperintensity on T2WI.
Like astrocytomas, gangliogliomas tend to be eccentrically located
within the spinal cord.
Tumoral cysts are more common in gangliogliomas than in either
astrocytomas or ependymomas.
25. Chronic bony changes, including scoliosis and erosions, are often
seen with gangliogliomas due to their relatively slow growth; these
are rarely seen with ependymomas or astrocytomas.
T1 signal characteristics of gangliogliomas are most often mixed,
possibly secondary to the fact that gangliogliomas have a dual cell
population composed of ganglion cells and glial elements.
T2 signal characteristics of gangliogliomas are generally
hyperintense, although surrounding edema is not as commonly
seen as with ependymomas or astrocytomas.
majority of gangliogliomas show patchy enhancement.
26.
27. HEMANGIOBLASTOMA
Nonglial, highly vascular neoplasms of unknown cell
origin.
Although most of these tumors (75%) are
intramedullary, they may involve the intradural space
or even be extradural.
Thoracic spinal cord > cervical spinal cord
Superficial location (subpial aspect)
Large size of syrinx compared to tumor
Vasuclar flow voids
Cyst with enhancing nodule
Edema
in association with Von Hippel-Lindau disease.
28. IMAGING
MR features of spinal hemangioblastoma depend on
the size of the tumor.
Small (<10 mm)- isointense on T1WI
hyperintense on T2WI
homogeneous enhancement,
Large (>10mm) - hypo or mixed onT1WI
heterogeneous on T2WI
heterogeneous enhancement
29.
30. INTRAMEDULLARYLYMPHOMA
Primary are extremely rare.
Non-Hodgkin variety and can occur in both immunocompromised
and immunocompetent patients.
Majority of these tumors occur in the cervical or thoracic regions of the
spinal cord.
solid tumors without necrosis.
Marked T2 hyperintensity and enhance following gadolinium
administration.
There is no associated syringomyelia.
Clinically, these patients initially respond to steroid treatment for a short
time but usually recur after treatment.
31. INTRAMEDULLARYMETASTASES
Intramedullary spinal cord metastases are rare.
Usually involve the cervical cord.
Most common primary tumors that metastasize to the spinal cord
include lung, breast, colon, lymphoma and kidney.
On MRI, metastases are
T1 hypointense,
T2 hyperintense and demonstrate
homogeneous enhancement.
The amount of surrounding edema is out of proportion to the size of
the lesion.
32.
33. PARAGANGLIOMA
Although spinal paragangliomas are rare, they are the third most
common primary tumor to arise in the filum terminale (after
ependymoma and astrocytoma).
MR typically reveal a well-circumscribed mass that is isointense
relative to the spinal cord on T1WI and iso- to hyperintense on
T2WI.
Hemorrhage is common (third most common after ependymoma
and hemangioblastoma) and a low signal- intensity rim (cap sign)
may be seen on T2WI.
Heterogeneous and intense enhancement.
Multiple punctate and serpiginous structures of signal void due
to high-velocity flow may be seen around and within the tumors on
all sequences.
37. MENINGIOMAS
Most spinal meningiomas are found in the thoracic spine,
followed by the craniocervical junction and the lumbar
region.
Although most thoracic and lumbar meningiomas are based
on the posterior dura, craniocervical ones may be anterior or
posterior in location.
38. Typically, these lesions demonstrate T1 and T2 signal that is
isointense with the spinal cord and display intense
homogeneous enhancement.
A dural tail may be seen, reflecting tumor spreador reactive
changes in the dura adjacent to the tumor.
CT may show intratumoral calcifications and this finding may aid
in distinguishing between meningiomas and nerve sheath tumors,
which do not contain calcifications.
Occasionally, spinal meningiomas have a plaque-like configuration
and may encircle the cord.
41. NERVE SHEATHTUMORS
Schwannomas and Neurofibromas.
Schwannomas are most common, while neurofibromas generally
occur in association with neurofibromatosis (especially NF-1).
Approximately 50% of nerve sheath tumors are Intradural-
Extradural (dumbbell- shaped) in location and 50 % are Purely
Extradural.
Malignant degeneration of neurofibromas may occur in patients with
NF-1, but schwannomas rarely undergo malignant transformation.
Both masses are slow growing and cause bone remodeling
(e.g., expansion of neural formina) and both show low T1 and
high T2.
42. .
Cystic spaces and hemorrhage, however, are more common in
schwannomas than in neurofibromas.
Both may show homogeneous or inhomogeneous
enhancement, but neurofibromas may have typical ring or
target type of enhancement in which the central portion of the
mass remains relatively hypointense after contrast
administration.
43.
44.
45. MyxopapillaryEpendymoma
Myxopapillary ependymomas represent the most frequent
type of ependymomas found at the conus medullaris-
cauda equina- filum terminale level.
Neuroectodermal tumors.
Mainly observed during the fourth decade of life.
The vast majority are intradural and extramedullary spinal
tumors
46. Imaging
Myxopapillary ependymomas are lobulated, sausage-shaped
masses that are often encapsulated.
Isointense relative to the spinal cord on T1WI a finding that reflects
mucin content or hemorrhage
and overall hyperintense on T2WI , low density may be due to
hemorrhage/calcifications.
T1 C+ (Gd)
• enhancement is virtually always seen
• the enhancement pattern is typically homogeneous. However,
they can have a variable enhancement pattern that, in part,
depends on the amount of hemorrhage present
47.
48. The differential diagnoses of a mass arising
in the filum terminale are:
Ependymoma,
Astrocytoma,
Nerve sheath tumor,
Metastases,
Paraganglioma,
Hemangioblastoma.
49. Leptomeningeal metastases
Frequently seen (5-15%) in the setting of solid tumors (most commonly melanoma,
small cell lung cancer, and breast cancer) and hematologic malignancies.
In children, the most common intradural extramedullary neoplasms are drop
metastases from primary brain tumors (most commonly medulloblastoma, others
include ependymoma,choroid plexus carcinoma, germinoma, ).
In adults, the most common drop metastases are from glioblastoma, anaplastic
astrocytoma, however non-CNS tumors are most commonly encountered. Multiple
lesions are common.
MRI
MRI without contrast may be normal, and thus when suspected contrast should be
administered. Typical signal characteristics include:
T1: thickened nerve roots or nodular lesions that are isointense with the spinal
cord.
T2: cord edema may be seen with more extensive disease, especially if there is an
intramedullary component
T1 C+ (Gd): enhancing tumor nodules on the spinal cord, nerve roots or cauda
equina, "sugar coating” of the spinal cord and nerve roots.
1 subarch space around mass sc complex is reduced
2displ cord to c/l side , widening of i/l csf space
3compress dural sac csf space displ cord to c/l side
Malignant ependymomas are quite rare.
These cysts are not specific for ependymomas and can be seen with
astrocytomas, hemangioblastomas and gangliogliomas.
Cap Sign can be seen in hemangioblastoma ,paraganglioma also.
An enhancing mass is present within the substance of the cervical cord centred at the C5 level. It is of intermediate signal intensity on T1 and T2 weighted sequences and demonstrates contrast enhancement. It is surrounded at either end by dilated cystic spaces which are not surrounded by enhancing tissue and may represent a tumour syrinx rather than part of the mass itself
with nonenhancing WHO grade II diffuse astrocytoma. Axial and sagittal T2-weighted MR images show a well-demarcated hyperintense intramedullary mass at the cervical spinal cord. The mass is slightly eccentric to the left side from the spinal cord center on the axial image. There is no peritumoral edema, periapical cap, or hemorrhage. C and D, The mass is hypointense on axial and sagittal T1-weighted images. E and F, Contrast enhanced T1-weighted images show that the mass is not enhanced at all.
Sagittal T2-weighted ) images reveal a T2-hyperintense intramedullary mass with circumscribed margins at the T7-T10 levels. The bamboo leaf sign refers to abrupt fusiform dilatation of the spinal cord on sagittal T2-weighted images.
Sagittal T2W1 showing cord expansion and hyperintense signal extending from the Th7 level to Th12 level surrounding both anterior and posterior aspects of cord.
Ganglioglioma in a 6-year-old girl with worsening right-sided weakness, shuffling gait, and decreased handwriting pressure for several weeks. (a, b) Sagittal T2-weighted (a) and contrast-enhanced T1-weighted (b) images reveal an enhancing longitudinally extensive intramedullary mass spanning the C1-T3 levels, with peripherally enhancing cystic change superiorly and a solidly enhancing T2-isointense tumor inferiorly
In patients with von Hippel- Lindau disease, hemangioblastomas are often multiple and this necessitates screening of the entire spine and brain.
Sagittal T2-weighted image reveals edema signal intensity throughout the cervicothoracic spinal cord, with cystic changes at the cervicomedullary junction, cervicothoracic junction, and lower thoracic cord. (b) Sagittal contrast-enhanced T1-weighted image reveals two large enhancing intramedullary masses at the C1-C2 and C7-T1 levels, with nontumoral cysts at their superior poles. Also visualized are five smaller enhancing nodules at the pial surface of the cervical and midthoracic cord.
an enhancing, well-circumscribed mass with secondary syringomyelia at the upper cervical level, indicating breast cancer with intradural intramedullary spinal cord metastasis (Figure).
A large intradural mass occupies much of the lumbar canal, below the tip of the conus, with evidence of bony remodelling. It is slightly hyperintense on T2 weighted imaging and isointense to cord on T1 with very large flow voids.
MRI demonstrates an intradural extramedullary tumor located at the L4 level and extending two vertebral body lengths. It completely fills the canal and remodels the posterior aspect of L4 (vertebral scalloping demonstrates homogenous vivid enhancement
A homogeneously enhancing intra-dural, extramedullary mass with a broad dural base, dural tail and in the vertebral canal anteriorly at the level of T1 is demonstated. It results in significant cord compression with flattening of the cord and obliteration of the CSF space.
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the cord representing the leaf and the stretched hypointense dentate ligament extending through the enhancing tumour as the stem
T1 CONTRAST A well defined dumbbell shaped intradural extramedullary lesion that shows avid enhancement following IV contrast administration. Localized remodeling and widening of neural foramen is noted.
MISME MULTIPLE INHER SCHW,MENIN,EPENDY
It is believed to arise from ependymal cells in the filum terminale
it can also manifest as an intramedullary mass within the conus medullaris
Homog enhancement
multiple innumerable variable size extramedullary intradural nodules . Those nodules are enhancing on T1C+ associated with leptomeningeal enhancement resembling "sugar coating".