Intradural Lesion, Serpentine



Intradural Lesion, Serpentine


Jeffrey S. Ross, MD



DIFFERENTIAL DIAGNOSIS


Common



  • CSF Flow Artifact


  • Vascular Malformation, Type 1


  • Vascular Malformation, Type 2


  • Redundant Roots due to Thecal Sac Compression



    • Central Stenosis


    • Herniation (Uncommon)


Less Common



  • Tumor Feeding Vessels



    • Hemangioblastoma, Spinal Cord


    • Ependymoma, Myxopapillary, Spinal Cord


    • Paraganglioma


    • Schwannoma


  • Hereditary Motor/Sensory Neuropathy


  • Collateral Veins/IVC Occlusion


  • Vascular Malformation, Type 3


  • Vascular Malformation, Type 4


  • Brain Dural A-V Fistula


ESSENTIAL INFORMATION


Helpful Clues for Common Diagnoses



  • CSF Flow Artifact



    • Related to both time-of-flight (TOF) effects and turbulent flow



      • TOF signal loss seen with SE or FSE when protons do not experience both initial RF pulse and subsequent refocusing pulse


      • Increased signal loss with higher flow velocity, thin slices, longer TE, imaging perpendicular to flow


      • GE imaging less susceptible to CSF flow artifacts


      • Turbulent flow leads to more rapid proton dephasing with signal loss


    • Repeat study with different plane of imaging, and GE sequences with short TE


  • Vascular Malformations



    • Most common is type 1 dural fistula



      • Lesions are extramedullary AVFs, not true AVMs


      • Venous drainage from the DAVF results in increased pial vein pressure that is transmitted to intrinsic cord veins


      • Venous hypertension from engorgement reduces intramedullary AV pressure gradient, causing reduced tissue perfusion & cord ischemia


      • Hallmark is T2 hyperintense cord (usually distal thoracic), intradural flow voids on cord surface, esp. dorsal


  • Redundant Roots due to Thecal Sac Compression



    • Seen with severe central canal stenosis or, much less commonly, large herniation


    • Typically seen cephalad to level of severe stenosis


Helpful Clues for Less Common Diagnoses



  • Tumor Feeding Vessels



    • Associated with vascular tumor such as ependymoma or hemangioblastoma


    • Look for primary enhancing soft tissue mass


Tags:
Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Intradural Lesion, Serpentine

Full access? Get Clinical Tree
Get Clinical Tree app for offline access