![]() ![]() They produce high signal intensity on proton density and T2 weighted images They cause either focal or diffuse spinal cord expansion Three general characteristics of intramedullary neoplasms are recognized on MRI: Generally not useful because bony changes are relatively rare. Widening of the interpedicular distance may be seen in less than 10% of cases CT An exception is intramedullary metastastases, which are diagnosed within one month of symptom onset in up to 75% of cases 6. Due to their non-specific nature, the diagnosis is often delayed. Motor regression and frequent falls may be the presenting features in young children 7. In children, progressive scoliosis may be seen. An uncommon presentation is acute headache due to subarachnoid hemorrhage 8. The most common presenting symptoms include back/neck pain, radicular pain, weakness, paresthesia, gait disturbance and bowel and bladder dysfunction. The presentation of intramedullary tumors depends on their size and location. Syringomyelia occurs in approximately 50% of all intramedullary tumors but is most frequently associated with hemangioblastomas 3. May resolve once the neoplasm is resected Present in 60% of all intramedullary spinal tumors Occur due to dilatation of the central canal Occur rostral or caudal to the solid portion of the tumor Occurs in association with the following proportion of tumors 5,6,9 Need to be resected along with the solid portion of the tumor because there is a high likelihood of neoplastic cells within the cyst wall May result from necrosis, fluid secretion, or degeneration of the neoplasm Typically demonstrate peripheral enhancement Intramedullary spinal neoplasms are more common in patients with neurofibromatosis:Įpendymomas occur more often in patients with NF2Īstrocytomas occur more often in patients with NF1Īpproximately 70% of intramedullary tumors are associated with cysts 3. Spinal glioblastoma multiforme (primary): 7.5% of all intramedullary gliomas and only 1.5% of all spinal cord tumors 11 Spinal ganglioglioma: 1% of all glial spinal cord tumors 5 Spinal astrocytoma: 33% of all glial spinal cord tumors 5 Spinal ependymoma: 60% of all glial spinal cord tumors 5 Glial neoplasms: 90-95% of all intramedullary tumors 5 They can be classified according to many ways: ![]()
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