Case Review -- Spine
Terms
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- What does transverse myelitis mean
- right well-defined cord lesion of any origin. It is not a review of the diagnosis.
- What real entities fall into this wastebasket diagnosis
- demyelinating disease (ADEM and MS), viral myelitis comic ischemia, compression due to tumor or hematoma.
- "Transverse myelitis" seen on scan
- scan the brain any time you see something confusing in the spine.
- Enhancing optic nerve on one side
- optic neuritis, optic glioma
- difference between spine and brain
- in brain, white matter is on the inside, gray matter is on the outside. In the spinal cord, it is the opposite. White matter is on the outside, gray matter on the inside. The gray matter in the spine makes the "H"
- Gray matter enhancement in the cord
- just like in the brain, infarct and viral encephalitis are most likely.
- Appearance of MS lesion in spine
- JUST LIKE IN BRAIN, well circumscribed, should be able to draw a circle around them
- Diffuse cord enhancement, mild expansion
- Lupus, Radiation -- can have mild edema and then bright area -- can represent overlapping port seam, with double radiation to one part of spine
- Diffuse or enhancement along surface of cord
- dural enhancement -- think sarcoid, low pressure headaches (causes thickening of brain and spinal dural swelling)
- Bright thick epidural space on T2
- you can't tell inflammed fat from fluid. You need a fat sat to determine wheter there is a collection there or not.
- Vertebrae destroyed, disk preserved
- TB, neoplasm
- Thick dura
- Pachymeningitis. TB is common cause. Could it be staph or strep? No
- Bright lesion on T2 with dark rim
- Infectious abscesses
- Always abnormal signal intensity pattern in spine
- Marrow darker than vertebral body on T1
- Osteomyelitis diskitis
- You should recommend biopsy to culture the organism in case recovery prolonged or recurrence
- Intradural intramedullary
- Ependymoma, astrocytoma, hemangioblastoma, lipoma, epidermoid, dermoid, syringohydromyelia, intramedullary AVM, mets/abscess (rare)