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Age: 23

Sex: Male

Indication: Abnormal gait

Save ("V")

Case #20


Findings

  • Large heterogeneously enhancing mixed solid and cystic intramedullary mass extending from the caudal medulla through the upper thoracic spine with associated cord expansion
  • Multiple foci of associated susceptibility artifact
  • Syrinx versus central intramedullary tumoral cyst spans C6-T2
  • Enlargement and enhancement of multiple bilateral exiting cervical nerve roots
  • Partially imaged bilateral cerebellopontine angle enhancing masses
  • Multilevel mild disc dessication and height loss in addition to uncovertebral spurring without significant spinal canal or neural foraminal stenosis
  • Enhancing subcutaneous nodule in the posterior neck at the level of T1 measuring 2 x 1 cm


Diagnosis

  • Ependymoma
  • Neurofibromatosis type 2

Sample Report

Constellation of findings is highly suggestive of neurofibromatosis type 2.

Large heterogeneously enhancing mixed solid and cystic intramedullary mass extending from the caudal medulla through the upper thoracic spine with associated cord expansion and areas of petechial hemorrhage, compatible with an ependymoma. Associated syrinx versus central intramedullary tumoral cyst spans C6-T2.

Partially imaged bilateral cerebellopontine angle enhancing masses which likely represent vestibular schwannomas. Recommend dedicated brain MR with and without contrast for further evaluation.

Enlargement and enhancement of multiple bilateral exiting cervical nerve roots compatible with nerve root schwannomas.

Enhancing 2 cm subcutaneous nodule in the posterior neck at the level of T1 of uncertain etiology. This should be amenable to direct visual inspection.


Discussion

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Images

Long segment expansile intramedullary tumor with cystic components (red arrows), a caudal cyst versus syrinx (yellow arrow), and heterogeneous enhancement (blue arrows) most consistent with an ependymoma. Postcontrast brain MRI from the same patient showing large bilateral cerebellopontine angle vestibular schwannomas extending into the internal auditory canals (red arrows).



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