A 45 y/o man with quadriparesia

 

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Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Razmin Aslani

 

Case Section

Neuroradiology

 

Patient's Information

Gender : Male
Age : 45

 

Clinical Summary

A 45 y/o man with quadriparesia

 

Imaging Findings

In axial CT scan and coronal and sagittal reconstructions and T1w, T2w and postGd sagittal and axial MRI we can see a dumbbell shaped extramedullary intradural enhancing mass in left side of C1-C2 spine which has widened intervertebral foramen.

 

Differential Diagnosis

meningioma neurofibroma schwannoma malignant nerve sheath tumor

 

Final Diagnosis

schwannoma

 

Discussion (Related Text)

Most benign nerve sheath tumors are found in an intradural extramedullary location. However, they may be completely extradural or have a dumbbell-shaped combined intra- and extradural location.On precontrast T1-weighted images, benign nervesheath tumors tend to be isointense to slightly hypointense to the spinal cord and to the nerve roots. Only the rare melanotic schwannomas appear hyperintense on nonenhanced T1-weighted sequences.Schwannomas are most commonly hyperintense on T2-weighted sequences. They may appear cystic in more than one third of cases. In about 10% of cases, schwannomas appear hemorrhagic. After intravenous contrast administration, schwannomas usually show pronounced enhancement that may be homogeneous or heterogeneous.(1) Schwannomas and neurofibromas may be indistinguishable by imaging alone, especially when solitary.However, the previously mentioned target sign is more common in neurofibromas, whereas hemorrhagic changes are more common in schwannomas(2) Spinal meningiomas are usually isointense to the spinal cord on precontrast T1-weighted sequences and on T2-weighted sequences. They are commonly round to ovoid, have a broad base toward the adjacent dura, and show pronounced contrast enhancement(3)

 

References

1-John R.Haaga , CT and MRI of the whole body , fifth edition 2009 , page 801-806. 2-Georgy BA, Hesselink JR: MR imaging of the spine: Recent advances in pulse sequences and special techniques. AIR Am J Roentgenol 162:923, 1994 3-Quekel LG, Versteege CW: The "dural tail sign" in MRI of spinal meningiomas. J Comput Assist Tomogr 19:890-892, 1995.

 

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