0:01

This was a 41-year-old adult who had motor

0:05

problems in the upper extremities,

0:07

predominantly affecting the fingers and the wrist region.

0:14

So the fingers tend to be associated with the

0:18

C7, C8 level of the spinal cord.

0:22

And as you can see,

0:23

this patient has an abnormality with cord widening

0:27

predominantly at the C5, C6, and C7 levels.

0:32

Note that this is a nice example of what one

0:35

would expect from an intradural intramedullary

0:39

lesion as the CSF space narrows

0:43

where the cord is widened,

0:45

identifying it as intradural intramedullary.

0:50

So in this situation,

0:51

again, with this large lesion of the spinal

0:55

cord in the cervical region,

0:57

we would generally favor an astrocytoma,

1:00

even though this is an adult.

1:02

Remember that the adults are more commonly

1:05

have ependymomas, but that's because of the dominance

1:08

of themyxopapillary ependymoma

1:11

of the lumbosacral region.

1:13

If we look at this lesion on axial scans,

1:17

we see that the cord signal is abnormal

1:20

predominantly on the left side as the cord expands,

1:24

but also affects the expected location of the

1:29

anterior corticospinal tracts,

1:31

as well as the gray matter of the spinal cord,

1:34

which is why the motor symptoms seemed to dominate.

1:37

On post-gadolinium enhanced scans,

1:40

this patient had a contrast enhancing

1:43

irregular lesion,

1:46

which I'm just going to blow up to show that

1:48

this is not unusual with astrocytomas,

1:52

that the enhancement is not homogeneous,

1:54

it's slightly irregular,

1:56

and that is also typical of an astrocytoma.

2:00

Now, unfortunately,

2:01

ependymomas may look the same with regard

2:04

to their enhancement characteristics.

2:07

You can have necrosis in a spinal cord lesion.

2:13

Here we see that area of irregular contrast

2:16

enhancement that identified the possibility

2:20

of a glioblastoma of the spinal cord.

2:25

So, most of the astrocytomas of the spinal cord are low grade.

2:29

That is, they're typically grade 1 or grade 2.

2:33

This particular individual had a glioblastoma,

2:36

which is decidedly uncommon when one considers

2:40

astrocytomas of the spinal cord.

2:43

The only way to suggest that diagnosis is

2:45

to identify the necrosis with the ring

2:48

enhancement on the post-gadolinium enhanced

2:52

sequences that identified necrotic area

2:55

within this spinal cord mass.

2:58

So, glioblastoma of the cervical spinal cord in

3:04

an adult presenting with myelopathic symptoms

3:07

predominantly motor in their symptomatology.