VONHIPPEL LINDAU DISEASE. Complex cystic lesion in the conus medullaris region with enhancing mural...

VONHIPPEL LINDAU DISEASE

Complex cystic lesion in the conus medullaris region with enhancing mural nodules.

Enhancing focus along thoracic cord

Intramedullary enhancing nodule in lower thoracic cord.

History: 12 year-old female with history of von Hippel Lindau disease.

Diagnosis: von Hippel Lindau Disease with spinal hemangioblastomas.

ACR Code: 38.3651

-- About 20% of spinal hemangioblastoma cases are associated with von Hippel-Lindau disease

-- Hemangioblastoma accounts for about 1-15% of all cord tumors, in which 85-90% are intramedullary.

-- MRI finding include: mural cyst (rimmed by enhancement) flow voids (hypervascular), and signs of hemorrhage.

Rheumatoid arthritis

Soft tissue mass (pannus) appears dark on the T1-weighted image and brighter on the T2-weighted image around the adontoid.

History: 68-year-old female with neck pain.

Diagnosis: Rheumatoid arthritis involving the C1-2 articulation.

ACR Code: 311.711

-- About 60-70% of patients with RA develop cervical spine symptoms sometime in the course of their disease.

-- Erosion of the dens occurs in 14-35% of patients with RA and is a consequence of synovial inflammation in adjacent joints.

Viral myelitis

Sagittal T1-weighted image of the cervical spine shows slight swelling of the cord at C3 through C5 levels, without abnormal signals.

Abnormal hyperintensity signals mostly involving the grey matter of the left hemicord

History: 34 year-old female with sudden onset of left arm weakness and sensory loss. Three months earlier she had been treated for herpes zoster of the left upper arm and neck. EMG showed a severe radicular lesion at the C5 and C6 level on the left.

Diagnosis: Varicella-Zoster viral myelitis.

ACR Code:

-- Herpes zoster represents a reactivation of latent varicella zoster virus (VZV) infection. Compromised immunity status increases the likelihood of VZV reactivation .

-- Myelitis is a rare complication of herpes zoster, which can be diagnosed based on the close temporal relationship between the onset of skin lesions and myelitis.

-- The virus can cause direct viral invasion of the cord, vasculitis with ischaemic necrosis, or via an immunological-parainfectious mechanism.

MRI findings in documented cases of VZV myelitis include:

-- diffuse hyperintensity on T2-weighted images that extends over several levels representingedema;

-- focal or multifocal enhancement on post-contrast T1-weighted images representing direct viral invasion or blood-cord barrier breakdown.

-- there can be cord swelling.