Ependymoma grade II, case 4

Clinical history
This 23-year-old female complained mainly of two years of difficulties in writing due to subtle weakness and paresthesia of the right hand.

Neurological examination
Minor motor deficit of both arms.

MR findings (courtesy O.L.V. AALST): first a brain MRI was ordered
Image 1: sagittal T1WI of the brain shows a cystic lesion in the upper cervical spinal cord.
Image 2: sagittal T2WI confirm the presence of a cystic, hyperintense spinal cord lesion, therefore a dedicated spinal MRI is performed.
Image 3: sagittal T1WI. The cervical cord is diffusely enlarged from the cervicomedullary to the cervicothoracic junctions. An isointense mass is identified with cystic cord enlargement above and below the lesion.
Image 4: sagittal T2WI. The solid component is slightly hyperintense to the cord on these T2WI and somewhat heterogeneous. At both ends, hyperintense "satellite" cysts are seen.
Image 5: Sagittal Gd T1WI. The solid nodule enhances intensely. No enhancement is seen within the margins of the cystic components indicating the non neoplastic character of the associated cysts.

Conclusion
C2-C7 intramedullary tumor.

Surgery
Complete resection of an intramedullary tumor was achieved.

Histology
Ependymoma grade II.

Immediate post-operative MRI
Image 6: Sagittal T1WI. and Image 7: Sagittal T2WI: A reduction of the size of the associated cysts is seen immediately after surgery. Intramedullary cystic appearance of the site of tumor resection.
Image 8: Sagittal GdT1WI and Image 9: Axial GdT1WI:
At the level of C6 a small enhancing lesion is still seen: post-operative changes versus residual tumor?

Clinical follow-up
Mild paresis of the left hand was observed immediately after surgery. Three months later however, favorable clinical evolution was reported, and the patient went back to work. At clinical examination, persistent mild sensory changes in the right hand remained.

Search also:
- Ependymoma

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