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Intramedullary- inflammatory lesion

 

Clinical history
This 37-year-old male complained of persistent paresthesia of the right arm associated with dysesthesia of the first three fingers of the right hand.

Neurological examination
Cervical flexion provokes selective electric sensation radiating into the right arm. Deep tendon sensation is also abnormal in the right arm. Accurate finger movements are difficult with the right hand. Absence of sensory changes.

MRI findings
Image 1: Sagittal T1WI show enlargement of the cervical spinal cord at the level of C3-C4. Image 2: Sagittal T2 WI. An ill defined high signal intensity area is seen associated with the cord enlargement.
Image 3: Axial T2WI: The hyperintense area involves almost the entire cord.
Image 4: Sagittal Gd T1WI: after Gadolinium injection, contrast uptake is seen mainly laterally to the right at the level of C4.
Image 5: Axial Gd T1WI and image 6: Coronal Gd T1WI confirm the focal area of contrast uptake in the right cervical cord at the level of C4.

Brain MRI is normal.

On control MRI (not shown here) performed 3 and 6 months later, no changes were seen. No major clinical changes were observed as well, and a spinal cord biopsy was finally performed with a pre-operative diagnosis of infiltrating tumor.

Surgery
Ill defined cord infiltration was found laterally to the right, within the posterior columns. A small biopsy was carefully performed.

Histology
Non specific inflammatory lesion.

Follow-up MRI
Progressive regression of the size of the lesion was observed. The site of biopsy corresponds precisely to the zone of contrast enhancement observed pre-operatively.

Post-operative MRI (1996)
Image 7: Sagittal T1WI. C3-C4 laminectomy. Persistence of the widening of the mid-cervical cord.
Image 8: Sagittal T2 WI. Less extensive high signal intensity area.
Image 9: Sagittal and image 10: axial GdT1WI. Contrast enhancement is still visible but is reduced in size compared to the pre-operative images.

Late post-operative MRI (1997)
Image 11: Sagittal T1WI: The size of the cervical spinal cord returned to normal.
Image 12: Sagittal T2WI and Image 13: Axial T2WI: Still a small high signal intensity area is to be seen at the site of biopsy.
Image 14: Sagittal GdT1WI and image 15: Axial GdT1WI. Contrast uptake is no longer seen.

Clinical follow-up
The patient was put on corticoid-therapy with the diagnosis of chronic inflammatory lesion. Clinical status remained unchanged with persistent sensation problems in the right arm.

 

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Fig. 1

Intramedullary- inflammatory lesion, Fig. 1
Intramedullary- inflammatory lesion, Fig. 2
Intramedullary- inflammatory lesion, Fig. 3
Intramedullary- inflammatory lesion, Fig. 4
Intramedullary- inflammatory lesion, Fig. 5
Intramedullary- inflammatory lesion, Fig. 6
Intramedullary- inflammatory lesion, Fig. 7
Intramedullary- inflammatory lesion, Fig. 8
Intramedullary- inflammatory lesion, Fig. 9
Intramedullary- inflammatory lesion, Fig. 10
Intramedullary- inflammatory lesion, Fig. 11
Intramedullary- inflammatory lesion, Fig. 12
Intramedullary- inflammatory lesion, Fig. 13
Intramedullary- inflammatory lesion, Fig. 14
Intramedullary- inflammatory lesion, Fig. 15