Intradural/Extramedullary, Leptomeningeal Enhancement



Intradural/Extramedullary, Leptomeningeal Enhancement


Kevin R. Moore, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Guillain-Barré Syndrome


  • Metastases, CSF Disseminated


  • Meningitis, Spinal


  • Ependymoma, Myxopapillary, Spinal Cord


  • Neurofibromatosis Type 1



    • Neurofibroma


Less Common



  • Neurofibromatosis Type 2



    • Schwannoma


  • Lymphoma


  • Leukemia


  • Chemical Meningitis


Rare but Important



  • Sarcoidosis


  • Arachnoiditis, Lumbar


  • Hypertrophic Neuropathy


  • Anterior Radiculopathy Syndrome


  • CIDP


  • Malignant Peripheral Nerve Sheath Tumors


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Distinguishing between smooth linear and nodular enhancement may help narrow the differential diagnosis list


  • Consider all known clinical information during imaging interpretation


Helpful Clues for Common Diagnoses



  • Guillain-Barré Syndrome



    • Autoimmune post-infectious or post-vaccinial acute inflammatory demyelination of peripheral nerves, nerve roots, cranial nerves


    • Best diagnostic clue is smooth pial enhancement of cauda equina and conus medullaris


  • Metastases, CSF Disseminated



    • Spread of malignant tumors through the subarachnoid space



      • Carcinoma, lymphoma/leukemia, brain neoplasms (drop metastases) most common source


    • Smooth or nodular enhancement along spinal cord pia, nerve roots


  • Meningitis, Spinal



    • Infection of spinal cord leptomeninges and subarachnoid space


    • Smooth or irregular diffuse extensive meningeal enhancement or diffuse cerebral spinal fluid (CSF) enhancement


  • Ependymoma, Myxopapillary, Spinal Cord



    • Slow-growing glioma arising from ependymal cells of filum terminale


    • Enhancing cauda equina mass ± hemorrhage occurring nearly exclusively in conus, filum terminale, cauda equina


  • Neurofibromatosis Type 1



    • Neurofibroma



      • Localized (90%), diffuse, or plexiform (pathognomonic for NF1) neoplasms of nerve sheath origin


      • Intradural/extramedullary common, may extend outside neural foramen in dumbbell shape


      • Cervical > thoracic, lumbar


Helpful Clues for Less Common Diagnoses

Tags:
Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Intradural/Extramedullary, Leptomeningeal Enhancement

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