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This next case ranks as the second most

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bizarre spinal cord lesion that I've ever seen.

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This was a child that had spastic quadriplegia.

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As we scroll on the T1-weighted scan, we see a

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lesion which is bright in signal intensity.

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It almost looks like the cord is coursing

0:24

through it, but in point of fact, on T2-weighted scan,

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this does not look like cord signal.

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And as we look at the border of the lesion,

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we see that indeed, this lesion is identified

0:39

as being intramedullary intradural.

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Now what would be bright on T1 and bright on T2?

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Well, we usually think in terms of blood

0:49

products, fat, melanin, gadolinium enhancement,

0:55

high protein, and in this case, when we look at

0:59

the STIR image, we can sort of sort things out.

1:03

The STIR image shows suppression of fat,

1:06

and indeed, this case represents a spinal cord lipoma.

1:15

If we go to the axial scans on

1:19

T1-weighted imaging, you see the bright

1:22

signal intensity against of fat, and the

1:24

cord is essentially replaced by the fat.

1:30

Very bizarre.

1:32

Quite enlarged.

1:34

Now, will Dr. Yousem

1:36

ever stop lying to you?

1:39

Most of the time, when we think

1:40

of a lipoma of this nature in a

1:44

child, it is of a congenital basis.

1:47

So, a dermoid, or a congenital lipoma rather

1:51

than being placed in the neoplastic category.

1:55

Now, some of you might still be

1:57

skeptical that this represents fat.

1:59

And for that reason, I will pull down

2:01

for your entertainment, the CT scan.

2:06

So here on the CT scan, we see the low

2:09

density of fat within this spinal cord lipoma,

2:16

a congenital lesion of the spinal cord.

2:21

But when we think of lipoma,

2:22

we usually characterize it as

2:25

either congenital or neoplastic.

2:29

So this is a very bizarre case,

2:31

but I will show you one that is even

2:34

more unusual in just the moment.

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Stay tuned.