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Abstract
Myelopathy can present acutely or more insidiously and has a broad differential diagnosis. In addition to the clinical history and neurologic examination, diagnostic testing, including MRI and cerebrospinal fluid analysis, as well as thorough review of patient comorbidities, risk factors, and potential toxic exposures, can help neurohospitalists distinguish between various causes and potentially start appropriate empiric therapy while awaiting definitive testing. This article focuses on how imaging can help in determining the most likely cause of myelopathy and highlights a range of causes, including compressive, vascular, metabolic and toxic, infectious, autoimmune, neoplastic, and paraneoplastic causes of spinal cord dysfunction.
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Affiliation(s)
- Anne G Douglas
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3 West Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Denise J Xu
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3 West Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Maulik P Shah
- Department of Neurology, University of California San Francisco, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143, USA.
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Kim J, Kim H, Kwon H. Non-Enhancing Intradural Extramedullary Ependymoma: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1341-1345. [PMID: 36238413 PMCID: PMC9432376 DOI: 10.3348/jksr.2020.0147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/14/2020] [Accepted: 12/31/2020] [Indexed: 11/25/2022]
Abstract
Spinal ependymomas are generally located in the intramedullary compartment in adults. Intradural extramedullary spinal ependymomas are extremely rare. Spinal ependymomas show various contrast enhancements on MRI. In this study, we report a rare case of a 52-year-old female who had a pathologically confirmed intradural extramedullary ependymoma that showed no enhancement on MRI.
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Affiliation(s)
- Jaemin Kim
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyunjung Kim
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyeongju Kwon
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
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Hussain I, Parker WE, Barzilai O, Bilsky MH. Surgical Management of Intramedullary Spinal Cord Tumors. Neurosurg Clin N Am 2020; 31:237-249. [PMID: 32147015 DOI: 10.1016/j.nec.2019.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Intramedullary spinal cord tumors (IMSCT) comprise a rare subset of CNS tumors that have distinct management strategies based on histopathology. These tumors often present challenges in regards to optimal timing for surgery, invasiveness, and recurrence. Advances in microsurgical techniques and technological adjuncts have improved extent of resection and outcomes with IMSCT. Furthermore, adjuvant therapies including targeted immunotherapies and image-guided radiation therapy have witnessed rapid development over the past decade, further improving survival for many of these patients. In this review, we provide an overview of types, epidemiology, imaging characteristics, surgical management strategies, and future areas of research for IMSCT.
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Affiliation(s)
- Ibrahim Hussain
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, 525 E. 68th St, New York, NY 10065, USA.
| | - Whitney E Parker
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, 525 E. 68th St, New York, NY 10065, USA
| | - Ori Barzilai
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Mark H Bilsky
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, 525 E. 68th St, New York, NY 10065, USA
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Asahar SF, Malek KA, Zohdi WNWM, Peter AB. Chronic Back Pain in a Young Female Patient: A Case of Ependymoma Originating from the Conus Medullaris. Korean J Fam Med 2020; 41:68-72. [PMID: 31902199 PMCID: PMC6987024 DOI: 10.4082/kjfm.18.0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/27/2018] [Indexed: 11/20/2022] Open
Abstract
We present the case of a 14-year-old Malay girl with an ependymoma of the conus medullaris who presented to multiple general practitioner clinics with a 24-month history of chronic low back pain. The pain was symptomatically managed as a simple musculoskeletal pain and sciatica. Further imaging to aid diagnosis was delayed until the appearance of severe pain with neurological deficits. Magnetic resonance imaging revealed an enhancing spinal mass at L1 through L3, and histopathological investigations confirmed the grade II ependymoma according to the World Health Organization classification. She underwent gross resection of the tumor. After the surgery, she developed neurogenic urinary bladder and bowel, which required intermittent self-catheterization, intermittent enema use, and intensive physical therapy.
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Affiliation(s)
- Siti Fairus Asahar
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang, Malaysia
| | - Khasnur Abd Malek
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang, Malaysia
| | - Wan Najwa Wan Mohd Zohdi
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang, Malaysia
| | - Alan Basil Peter
- Department of Radiology, Faculty of Medicine, Universiti Teknologi MARA, Selayang, Malaysia
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Hojjati M, Garg V, Badve CA, Abboud SE, Sloan AE, Wolansky LJ. Differentiation of recurrent spinal ependymoma from postradiation treatment necrosis through multiparametric PET-MR and perfusion MRI. Clin Imaging 2016; 41:48-52. [PMID: 27816875 DOI: 10.1016/j.clinimag.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 08/24/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Abstract
A 67-year-old male presented with papilledema and back pain localized to the T10 level. Initial workup revealed multifocal spinal ependymoma which was resected and treated with external beam radiotherapy. Nine years after treatment, the patient had a relapse of back pain, and MRI was inconclusive in distinguishing posttreatment radiation necrosis from recurrent tumor. We present the first described report with the utilization of multiparametric positron emission tomography-magnetic resonance imaging and perfusion MRI to distinguish recurrent spinal ependymoma from radiation necrosis.
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Affiliation(s)
- Mojgan Hojjati
- Diagnostic Neuroradiology, Department of Radiology, Cleveland, OH
| | - Vasant Garg
- Diagnostic Neuroradiology, Department of Radiology, Cleveland, OH
| | - Chaitra A Badve
- Diagnostic Neuroradiology, Department of Radiology, Cleveland, OH
| | - Salim E Abboud
- Diagnostic Neuroradiology, Department of Radiology, Cleveland, OH
| | | | - Leo J Wolansky
- Diagnostic Neuroradiology, Department of Radiology, Cleveland, OH.
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Chou SC, Chen TF, Kuo MF, Tsai JC, Yang SH. Posterior vertebral scalloping of the lumbar spine due to a large cauda equina paraganglioma. Spine J 2016; 16:e327-8. [PMID: 26656167 DOI: 10.1016/j.spinee.2015.11.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/13/2015] [Accepted: 11/19/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Sheng-Che Chou
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei, 10002, Taiwan
| | - Te-Fu Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei, 10002, Taiwan
| | - Meng-Fai Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei, 10002, Taiwan
| | - Jui-Chang Tsai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei, 10002, Taiwan
| | - Shih-Hung Yang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei, 10002, Taiwan
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