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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)

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