0:00

Well, I'm going to continue my theme of the mea culpa

0:04

and admit that I've lied to you yet again.

0:08

So let's look at this case and identify one of

0:11

Dr. Yousem's fabrications.

0:14

So here on this post gadolinium-enhanced scan

0:16

of a patient who has known von Hippel-Lindau

0:19

disease, where the patient has already had a

0:22

hemangioblastoma resected, we see that there

0:26

are contrast-enhancing nodules once again,

0:29

bilaterally in the cerebellum, both at the

0:34

vermis as well as in the lateral hemisphere.

0:37

You note that there are

0:38

post-operative changes from a previous

0:40

hemangioblastoma that has been resected.

0:44

So as I scroll through the brain

0:46

tissue, when I'm looking at a patient

0:48

who has a known hemangioblastoma,

0:50

a couple of things to remind you.

0:52

Remember that you can have retinal

0:54

hemangioblastomas, so look at the back

0:57

of the orbits and make sure there's

0:58

no areas of contrast enhancement.

1:01

And remember that the patient who has Von Hippel-Lindau

1:03

disease also has a predilection for

1:06

endolymphatic sac tumors, which was demonstrated

1:08

on the previous example of a Von Hippel-Lindau

1:12

patient who had a left temporal bone lesion.

1:16

Let's move to the spine and try to

1:19

identify a spinal cord hemangioblastoma.

1:23

And I told you that these lesions

1:25

are typically cystic and solid.

1:28

So as we scroll through the spine,

1:29

we don't see anything within the spinal cord.

1:34

Here's the lie.

1:37

So I'm going to magnify this case

1:39

and demonstrate another manifestation

1:44

of von Hippel-Lindau disease.

1:46

And that is, you can get intradural

1:51

extramedullary masses associated with

1:56

Von Hippel-Lindau disease and hemangioblastomas

1:58

on the surface of the spinal cord.

2:01

And you may see these down in the

2:04

cauda equina nerve roots as well.

2:07

So when you have multiple hemangioblastomas

2:10

of the spinal, of the, uh, von Hippel-Lindau

2:13

disease, you have to look not only in the

2:16

cord, but intradural extramedullary for the

2:20

potential of little seeds of hemangioblastomas.

2:24

Now I'm using the term seeds here, not to

2:27

imply that these are subarachnoid seeding the

2:31

intracranial hemangioblastoma, but instead, small

2:35

PIL-based (PIAL) hemangioblastomas

2:40

on the surface of the spinal cord and

2:43

potentially in the cauda equina nerve roots.

2:45

So, another manifestation of Von Hippel-Lindau

2:50

disease and hemangioblastoma of the spinal cord.