0:01

This is another patient who presented with low

0:03

back pain but had an element of fecal and

0:06

urinary incontinence associated with it.

0:09

We have the T1-weighted scan to the left,

0:11

the T2-weighted scan centrally,

0:13

and the STIR image on the right-hand side.

0:15

It's pretty clear that we have this mass that

0:18

is centered at the L1-L2 disc level.

0:20

We would describe this lesion as being intradural

0:25

extramedullary because it does indeed have

0:28

that meniscus sign of CSF above and below it.

0:32

That is the widening of the CSF space.

0:35

We also know that this is intradural extramedullary

0:37

because we are at a level where we

0:39

are below the spinal cord termination,

0:42

generally at the L1 level or L2 level,

0:45

and therefore this is going to be in

0:46

the intradural extramedullary space.

0:49

This is a purely solid lesion.

0:51

In this location,

0:52

we have a differential diagnosis which would

0:54

include either a meningioma or a schwannoma.

0:57

But just looking at the numbers in the lumbar

1:00

level, schwannomas outnumber Meningiomas,

1:03

this lesion does have a basis that it is along

1:08

the posterior dura and therefore it could have

1:11

arised from this posterior dura and could be a

1:15

meningioma. Let's look at the axial scans.

1:19

I'm just going to window these a little

1:20

bit better for the audience.

1:22

And here we have the mass on the T2-weighted

1:25

axial scan. And it is, as you can see,

1:31

intradural within the thecal sac,

1:33

but outside the spinal cord,

1:36

which is demonstrated above the lesion.

1:39

So here's the termination of the spinal cord,

1:41

the so called conus medullaris,

1:43

and then we rise with this mass.

1:46

So the post-gadolinium-enhanced scans,

1:48

which were not performed since this was

1:50

done as a DJD low back pain protocol,

1:56

might help us in distinguishing between a

1:58

schwannoma versus a meningioma, in that

2:01

meningiomas tend to have a dural

2:05

based tail as opposed to schwannomas,

2:08

which do not have that dural enhancement

2:11

associated with it. In this case,

2:14

just based on the numbers,

2:15

we would say schwannoma favored over meningioma.

2:19

Recommend gadolinium-enhanced pulse sequences

2:23

for further evaluation.