Expansile, enhancing cervical cord lesion with an associated syrinx secondary to demyelination

2007 ◽  
Vol 6 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Allen Waziri ◽  
Jean-Paul Vonsattel ◽  
Michael G. Kaiser ◽  
Richard C. E. Anderson
Keyword(s):  
Spinal Cord ◽  
Demyelinating Disease ◽  
Cervical Spinal Cord ◽  
Inpatient Rehabilitation ◽  
Tissue Loss ◽  
Cervical Cord ◽  
High Dose ◽  
Histopathological Analysis ◽  
Dural Graft ◽  
Cord Lesion

✓The authors describe the case of a patient with an enhancing, intramedullary cervical spinal cord lesion and associated syrinx. Biopsy sampling of the cervical lesion was performed, and the histological findings were consistent with a demyelinating process supporting the diagnosis of multiple sclerosis (MS). Syrinx formation associated with demyelinating disease has only been described in isolated cases, almost exclusively in Japanese patients with MS. A 22-year-old woman of Caribbean descent presented with a subacute, progressive myelopathy including symptoms of pain and weakness in all extremities, bladder incontinence, and the inability to ambulate. Magnetic resonance imaging of the brain and spinal cord demonstrated an enlarged cervical cord with enhancement and central cavitation consistent with a syrinx. The patient underwent a C3–7 laminoplasty and placement of a dural graft for cord decompression as well as fenestration of the central syrinx. Biopsy sampling of the lesion was performed, and the histopathological analysis, in conjunction with subsequent laboratory and diagnostic testing, supported the diagnosis of demyelinating disease. After treatment with a course of high-dose dexamethasone and inpatient rehabilitation therapy, the patient demonstrated significant clinical improvement. Spinal cord involvement is not uncommon in patients with demyelinating disease; however, enhancing lesions associated with extensive tissue loss and syrinx formation have rarely been reported. For the consulting neurological surgeon, demyelinating disease should be included in the differential diagnosis of such lesions given the level of complexity and risk to the patient associated with open biopsy of the spinal cord.

Spinal cord oligodendroglioma with 1p and 19q deletions presenting with cerebral oligodendrogliomatosis

2009 ◽  
Vol 10 (6) ◽  
pp. 557-563 ◽  
Author(s):  
Kern H. Guppy ◽  
Paul T. Akins ◽  
Gregory S. Moes ◽  
Michael D. Prados
Keyword(s):  
Spinal Cord ◽  
Tumor Cells ◽  
Cervical Spinal Cord ◽  
Cervical Cord ◽  
Meningeal Enhancement ◽  
Who Grade ◽  
Term Survival ◽  
Radiographic Findings ◽  
Grade Ii ◽  
Cord Lesion

Oligodendroglioma of the spinal cord is a rare tumor that most often presents with spinal cord symptoms. The authors present a case of spinal cord oligodendroglioma that was associated with cerebral rather than spinal cord symptoms. A 30-year-old woman developed nausea, vomiting, and severe headaches. Magnetic resonance imaging of the brain showed meningeal enhancement. The patient underwent a craniotomy with biopsies of the meninges and brain. The biopsy findings revealed an abnormal arachnoid thickening without tumor cells. The patient later developed hydrocephalus and underwent shunt placement. Cerebrospinal fluid cytological findings were negative for tumor cells or infection. She was found to have a cervical cord lesion at C3–4 that was initially nonenhancing but later enhanced after Gd administration. Biopsy of the cord lesion with partial resection showed a WHO Grade II oligodendroglioma with 1p and 19q deletions determined by fluorescence in situ hybridization. Neurooncological treatment with tumor radiation and temozolomide (Temodor) resulted in improvement in radiographic findings, symptoms, and long-term survival. This paper presents an extensive review of the literature, which revealed only 2 other reported cases of cerebral symptoms in adults that preceded spinal cord symptoms in a patient with oligodendroglioma of the spinal cord. It is also the first reported case of oligodendrogliomatosis due to a cervical spinal cord oligodendroglioma with 1p and 19q deletions.

Intraoperative MR imaging in a case of a cervical spinal cord lesion

2011 ◽  
Vol 14 (6) ◽  
pp. 754-757 ◽  
Author(s):  
David Netuka ◽  
Svatopluk Ostrý ◽  
Tomáš Belšán ◽  
Filip Kramář ◽  
Vladimír Beneš
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Spinal Cord Lesion ◽  
Cervical Cord ◽  
Cervical Pain ◽  
Neck Flexion ◽  
Before And After ◽  
Cord Lesion

The aim of this article is to describe the feasibility of performing intraoperative MR imaging in patients with spinal cord lesions and the potential value of this technique. The authors report a case involving a 28-year-old man who presented with chronic cervical pain and pain along the ulnar side of the forearms during neck flexion. Findings on clinical examination were normal, but MR imaging revealed a multicystic cervical spinal cord lesion. Surgery was undertaken to open the cysts, evacuate old blood, and search for pathological tissue. Intraoperative MR imaging showed that the caudal cyst was not opened, and surgery was therefore continued. The caudal cyst was fenestrated and a suspected small cavernous malformation was removed. Electrophysiological monitoring was performed both before and after the intraoperative MR imaging. The use of intraoperative MR imaging changed the strategy of the procedure and helped the surgeon to safely enter all the cysts in the cervical cord.

scholarly journals Grey matter involvement by focal cervical spinal cord lesions is associated with progressive multiple sclerosis

2015 ◽  
Vol 22 (7) ◽  
pp. 910-920 ◽  
Author(s):  
Hugh Kearney ◽  
Katherine A Miszkiel ◽  
Marios C Yiannakas ◽  
Daniel R Altmann ◽  
Olga Ciccarelli ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Grey Matter ◽  
Cervical Spinal Cord ◽  
Spinal Cord Lesion ◽  
Cervical Cord ◽  
Focal Lesions ◽  
Lateral Column ◽  
Cord Lesion

Background: The in vivo relationship of spinal cord lesion features with clinical course and function in multiple sclerosis (MS) is poorly defined. Objective: The objective of this paper is to investigate the associations of spinal cord lesion features on MRI with MS subgroup and disability. Methods: We recruited 120 people: 25 clinically isolated syndrome, 35 relapsing–remitting (RR), 30 secondary progressive (SP), and 30 primary progressive (PP) MS. Disability was measured using the Expanded Disability Status Scale. We performed 3T axial cervical cord MRI, using 3D-fast-field-echo and phase-sensitive-inversion-recovery sequences. Both focal lesions and diffuse abnormalities were recorded. Focal lesions were classified according to the number of white matter (WM) columns involved and whether they extended to grey matter (GM). Results: The proportion of patients with focal lesions involving at least two WM columns and extending to GM was higher in SPMS than in RRMS ( p = 0.03) and PPMS ( p = 0.015). Diffuse abnormalities were more common in both PPMS and SPMS, compared with RRMS (OR 6.1 ( p = 0.002) and 5.7 ( p = 0.003), respectively). The number of lesions per patient involving both the lateral column and extending to GM was independently associated with disability ( p < 0.001). Conclusions: More extensive focal cord lesions, extension of lesions to GM, and diffuse abnormalities are associated with progressive MS and disability.

Occipital neuralgia associates with high cervical spinal cord lesions in idiopathic inflammatory demyelinating disease

Cephalalgia ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Narayan R Kissoon ◽  
James C Watson ◽  
Christopher J Boes ◽  
Orhun H Kantarci
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Demyelinating Disease ◽  
Cervical Spinal Cord ◽  
Progressive Multiple Sclerosis ◽  
Sensory Loss ◽  
High Dose ◽  
Occipital Neuralgia ◽  
Spinal Cord Lesions ◽  
High Cervical

Background The association of trigeminal neuralgia with pontine lesions has been well documented in multiple sclerosis, and we tested the hypothesis that occipital neuralgia in multiple sclerosis is associated with high cervical spinal cord lesions. Methods We retrospectively reviewed the records of 29 patients diagnosed with both occipital neuralgia and demyelinating disease by a neurologist from January 2001 to December 2014. We collected data on demographics, clinical findings, presence of C2-3 demyelinating lesions, and treatment responses. Results The patients with both occipital neuralgia and multiple sclerosis were typically female (76%) and had a later onset (age > 40) of occipital neuralgia (72%). Eighteen patients (64%) had the presence of C2-3 lesions and the majority had unilateral symptoms (83%) or episodic pain (78%). All patients with documented sensory loss (3/3) had C2-3 lesions. Most patients with progressive multiple sclerosis (6/8) had C2-3 lesions. Of the eight patients with C2-3 lesions and imaging at onset of occipital neuralgia, five (62.5%) had evidence of active demyelination. None of the patients with progressive multiple sclerosis (3/3) responded to occipital nerve blocks or high dose intravenous steroids, whereas all of the other phenotypes with long term follow-up (eight patients) had good responses. Conclusions A cervical spine MRI should be considered in all patients presenting with occipital neuralgia. In patients with multiple sclerosis, clinical features in occipital neuralgia that were predictive of the presence of a C2-3 lesion were unilateral episodic symptoms, sensory loss, later onset of occipital neuralgia, and progressive multiple sclerosis phenotype. Clinical phenotype predicted response to treatment.

scholarly journals MR diffusion tensor imaging of the spinal cord: can it help in early detection of cervical spondylotic myelopathy and assessment of its severity?

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Talaat Ahmed Abd El Hameed Hassan ◽  
Ramy Edward Assad ◽  
Shaimaa Atef Belal
Keyword(s):  
Spinal Cord ◽  
Diffusion Tensor Imaging ◽  
Early Detection ◽  
Cervical Spondylotic Myelopathy ◽  
Diffusion Tensor ◽  
Cervical Spinal Cord ◽  
Cervical Cord ◽  
Mr Diffusion ◽  
Compressive Myelopathy ◽  
Mr Diffusion Tensor Imaging

Abstract Background The aim of this study is to evaluate the potential application of MR diffusion tensor imaging (with calculation of fractional anisotropy (FA) values) in assessment of the spondylotic cervical spinal canal compromise and comparison with the information issued from conventional MR sequences for early detection of cervical spondylotic myelopathy (CSM). Thirty patients (11 males and 19 females) were included in this study; age ranged from 22 to 70 years (mean age = 44). All patients had conventional and diffusion tensor imaging (DTI) examinations of the cervical spine for detection and assessment of degree of cervical cord myelopathy. FA values of the whole cord circumference and at 3, 6, 9, 12 o’clock positions of the normal cord (opposite to C2), opposite to the most affected disc, and below the level of the most affected disc were measured. Results High statistically significant P values were obtained when comparing the FA values of the normal cord with the cord opposite to the most affected disc, the normal cord with the cord below the affected disc and the cord at the level of the most affected disc with the cord below the level of the most affected disc. Conclusions DTI of the cervical spinal cord with FA measurement in patients with cervical spondylosis helps in early detection of cervical cord compressive myelopathy prior to appearance of changes in conventional MRI, which can improve the clinical outcome and help in treatment plans.

Deformation of the cervicomedullary junction and spinal cord in a surgically treated adult Chiari I hindbrain hernia associated with syringomyelia: a magnetic resonance microscopic and neuropathological study

1996 ◽  
Vol 85 (4) ◽  
pp. 701-708 ◽  
Author(s):  
Emile A. M. Beuls ◽  
Marie-Anne M. Vandersteen ◽  
Linda M. Vanormelingen ◽  
Peter J. Adriaensens ◽  
Gerard Freling ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Magnetic Resonance ◽  
Cervical Spinal Cord ◽  
Cervical Cord ◽  
Magnetic Resonance Microscopy ◽  
Type I ◽  
Additional Advantage ◽  
Content Type ◽  
Hindbrain Hernia ◽  
Fine Print

✓ The lower brainstem and cervical spinal cord from an ordinarily treated case of Chiari Type I hindbrain hernia associated with syringomyelia was examined using high-resolution magnetic resonance microscopy and standard neuropathological techniques. Magnetic resonance microscopy allows total screening and visualizes the disturbed internal and external microanatomy in the three orthogonal planes with the resolution of low-power optical microscopy. An additional advantage is the in situ visualization of the shunts. Afterwards the intact specimen is still available for microscopic examination. Part of the deformation of the medulla is caused by chronic tonsillar compression and molding inside the foramen magnum. Other anomalies, such as atrophy caused by demyelination, elongation, and unusual disturbances at the level of the trigeminal and solitary nuclear complexes contribute to the deformation. At the level of the syrinx-free upper part of the cervical cord, anomalies of the dorsal root and the dorsal horn are demonstrated.

scholarly journals ML-05 A CASE OF NEUROLYMPHOMATOSIS ARISED SECONDARILY FROM PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii33-ii33
Author(s):  
Keishi Horiguchi ◽  
Hirofumi Asano ◽  
Tadashi Osawa ◽  
Masahiko Tosaka ◽  
Yuhei Yoshimoto
Keyword(s):  
Spinal Cord ◽  
Fdg Pet ◽  
Peripheral Nerves ◽  
Initial Treatment ◽  
Cervical Spinal Cord ◽  
Intrathecal Injection ◽  
Cranial Nerves ◽  
Central Nervous System Lymphoma ◽  
High Dose ◽  
Whole Brain Irradiation

Abstract A woman in her 40s. A biopsy of multiple intracranial lesions was performed, and the patient was diagnosed with DLBCL. As an initial treatment, 6 courses of high dose MTX therapy were performed and CR was achieved. Radiation therapy was not desired by the patient. On the 19th month after initial treatment, tumor recurrence was confirmed by MRI and added 2 courses of HD-MTX. On the 23rd month, second recurrence around the left basal ganglia were observed. One additional course of HD-MTX was performed, but due to the appearance of renal damage that was thought to be acute tubular necrosis, additional HD-MTX was not performed and whole brain irradiation was performed. She began complaining of pain in the trunk and extremities during radiation. When MRI and FDG-PET were performed in the 25th month, multiple lesions were found in the ganglia, plexus, and peripheral nerves from the cervical spinal cord to the sacral spinal cord. Cerebrospinal fluid cytology revealed atypical lymphocytes and lymphoma dissemination in the spinal cord. When intrathecal administration of the anticancer agent was performed nine times weekly, the CSF cytology was negative. Imaging findings showed that the lesions relapsed, although the lesions were temporarily reduced. After confirming that the renal function had recovered, two additional courses of HD-MTX were performed. Accumulation of FDG-PET in the lesion disappeared in the 29th month. However, peripheral neuropathic pain and paraplegia remained. Discussion: Neurolymphomatosis is considered to be a clinically rare disease that presents invasion of lymphoma into peripheral nerves including the cranial nerves, nerve roots or plexus. Diagnosis of NL has been required to be proved by nerve biopsy or autopsy, but noninvasive FDG-PET has been reported to be effective. In this case, CR was not obtained with anticancer drug intrathecal injection, and HD-MTX therapy was successful.

Studies of experimental cervical spinal cord transection

1979 ◽  
Vol 50 (5) ◽  
pp. 629-632 ◽  
Author(s):  
Phillip A. Tibbs ◽  
Byron Young ◽  
Michael G. Ziegler ◽  
R. G. McAllister
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Plasma Concentrations ◽  
Spinal Cord Transection ◽  
Cervical Cord ◽  
Control Group ◽  
Content Type ◽  
Hemorrhagic Necrosis ◽  
Anesthetized Dogs ◽  
Experimental Group

✓ Plasma concentrations of norepinephrine (NE) were measured by a radioenzymatic assay technique before and serially after laminectomy at the C-6 level in 14 anesthetized dogs. In half the animals, no further procedures were carried out (control group); in the other dogs, cervical cord transection was performed in addition to laminectomy (experimental group). Mean plasma NE levels were similar in both groups after laminectomy and before cord interruption. In the control group, NE levels increased gradually for 2 hours after the procedure. In the group with cord transection, however, NE rose immediately after transection to 267% of the baseline value, then fell to 25% of the plasma NE level in the control group at 30 minutes, 29% at 60 minutes, and 15% at 120 minutes. Cervical spinal cord transection, therefore, results in an abrupt but short-lived increase in plasma NE concentrations. These changes in plasma NE levels may explain, at least in part, the hemodynamic alterations and the acute central hemorrhagic necrosis that occur after high spinal cord trauma.

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