Spine tumors 2 - Intramedullary lesions

In this lecture in the spine tumor series, we take a look at intramedullary lesions within the spinal cord. These are lesions that are within the dura and the substance of the spinal cord.
0:15 The most common intramedullary tumors are primary tumors of the cord itself, most commonly ependymomas and astrocytomas. Other things such as hemangioblastoma and cavernous malformations can also happen in the spinal cord. For the rest of this lecture, we take a look at a few case based examples of intramedullary tumors.
1:08 Case 1 - Astrocytoma. Astrocytomas are the second most common cord tumors and the most common tumors in young adults. They frequently have enhancement. Low grade tumors (grade 2) are the most common although glioblastomas/high grade tumors can also occur.
2:26 Case 2 - Ependymoma. Ependymomas are the most common cord tumors and the most common tumors in adults. They often have a cystic appearance with a well marginated nodular lesion. Hemorrhage and a “cystic cap” are common. Ependymomas are associated with neurofibromatosis type 2.
3:54 How to differentiate astrocytomas from ependymoma. Ependymomas are usually older patients with shorter segment lesions and well-defined margins, while astrocytomas are younger patients with more ill-defined margins.
5:45 Cord glioblastoma. Intramedullary glioblastoma has the same appearance as glioblastoma and appears like a high-grade lesion with mass effect, ill-defined margins, and necrosis.
7:06 Case 3 - Hemangioblastoma. Hemangioblastomas are common cord tumors and are associated with Von Hippel Lindau (VHL) syndrome. 1/3 are associated with the syndrome while 2/3 are spontaneous. Tumors often appear as a cyst with an enhancing nodule. You may see flow voids similar to those you see in the brain, although they are often harder to see. Patients with VHL may also have brain hemangioblastomas, endolymphatic sac tumors, and other systemic tumors (such as renal tumors).
9:22 Case 4 - Cavernous malformation. Cavernous malformations, sometimes referred to as cavernomas, can occur in the spinal cord. They have a similar appearance to cavernous malformations in the brain, often with a rim of siderosis and central T1 and T2 hyperintensity. Little to no enhancement is common.
11:04 Causes of hematomyelia (blood in the spinal cord). The differential for hematomyelia includes coagulation disorder, vascular malformations, anticoagulation medications, trauma, or cord tumor with repeated hemorrhage.
11:34 Take-home points.
- The spinal cord is an extension of the brain and affected by similar pathologies
- Tumors are the most common pathology. Astrocytomas (under 20 years old) and ependymomas (over 20 years old)
- Other tumors can also affect the spinal cord
Check out this video and additional content on www.learnneuroradiology.com

[@caiyu538]

Thank you for sharing. With the excellent teachers like you in KZbin, learning becomes much easier. Thank you so much.

[@LearnNeuroradiology]

You're very welcome!

[@caiyu538]

Always worth to revisit. Excellent lectures. Great teacher.

[@skeletopedia3122]

Thanks for the enhancement differences between astrocytoma and ependymoma.

[@LearnNeuroradiology]

No problem! Thanks for tuning in!

[@frankrobert9199]

Great lectures.

[@darja546]

Excellent! Thank you very much!

[@LearnNeuroradiology]

You are welcome!

[@faicalhaouari4489]

excellent lecture Dr Weinberg , thanx a lot

[@LearnNeuroradiology]

Most welcome! Thanks for tuning in!

[@dr.firasqawasmi4699]

Thanks 👍 😊

[@LearnNeuroradiology]

Welcome 😊

[@frankrobert9199]

excellent

[@LearnNeuroradiology]

Thank you! Cheers!

[@pradnyaalne760]

Amazing 🤩

[@LearnNeuroradiology]

Thank you! Cheers!

[@kishorkumarb3192]

Sir, can’t be the haemangioblastoma is first differential than ependymoma for 2nd case because of cyst with enhancing mural nodule appearance ?

[@rkunaln]

Sir, in mri I have an expensive t2 hyperintense lesion in upper cervical cord at c2/c3 level without significant enhancement and isointense to chord in t1 lesion measures about 3x1. 1x1.2 cm what does that mean?

[@LearnNeuroradiology]

You can't say with only that information. Tumor, demyelination, inflammatory disease, sarcoid could all be considered. You should talk to your doctors about the results

[@rkunaln]

@@LearnNeuroradiology Okay Sir ... Sir is there any risk factor associated with frequent mri?

[@LearnNeuroradiology]

@@rkunaln No, not particularly. Millions of MRIs are administered a year with very low risk. It is unknown whether accumulation of contrast agents is bad, so we try to administer them only when needed. Otherwise, it's quite safe.

[@pinalvaghasiya9560]

I have intradural lipoma in my spine. Can it old or new growth

[@LearnNeuroradiology]

Most lipomas do not grow, although they can change size over time slowly if they accumulate fat. Most of the time they are nothing to worry about.

[@rkunaln]

I am a 21 yr old male and recently I have undergone MRI for shoulder pain and shaking of hand....In MRI report it has been found that I have an intramedullary expensive t2 hyperintense lesion in upper cervical cord at c2/c3 level without significant enhancement and isointense to chord in t1 lesion measures about 3x1. 1x1.2 cm I feel pain while I sleep in right side...otherwise I don't have any other problem. I am doing well and I don't have any other issues apart from this... What could be my problem Sir?

[@LearnNeuroradiology]

You'll have to talk to your doctors about that because it could be a lot of things, including demyelination, a tumor, or related to infection.

[@cindygoodin8758]

Is a lesion a tumor?

[@LearnNeuroradiology]

A lesion is an area of injury or other tissue abnormality. It does not have to be a tumor. It could be from infection, inflammation, trauma, or other causes.