Metastasis, case 4

Clinical history
This 13-year-old patient presented with a highly malignant posterior fossa tumor: medulloblastoma grade IV. Partial removal of the tumor was achieved and adjuvant chemotherapy given. Two months after surgery, the patient was admitted emergently with hydrocephalus and was shunted. A follow-up MRI of the brain and spine was then performed which disclosed multiple metastasis.

Image 1: Sagittal T1WI. A large intramedullary lesion is clearly seen at the level of C4-C5. At both ends, low signal areas are seen corresponding to associated cystic components.
Image 2: Sagittal Gd T1WI images show heterogeneous contrast enhancement within this upper cervical spinal cord metastasis. Multiple smaller sub-pial metastatic lesions are better identified after Gadolinium injection.
Image 3: Axial Gd T1WI.
Image 4: Axial T2WI.
These images confirm the intramedullary location of the mid-cervical intramedullary metastasis.
Image 5: Sagittal T2WI. The multifocal enlargement of the spinal cord is well demonstrated. Multiple intra- and extramedullary metastatic dissemination is evident on this T2WI. The intramedullary lesions are slightly hyperintense.

Comment
This case illustrates the fact that both multiple intramedullary and intradural extramedullary metastasis may be found.

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- Metastasis

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