0:00

So because I've been lying to you, I decided to

0:02

give you a little bonus case just to start

0:05

out the neoplastic category of disease.

0:08

Here we have a T2-weighted scan in the

0:12

center and a sagittal STIR image to the right.

0:15

As we scroll through the T2-weighted scan, you

0:19

see that there is cord expansion beginning at

0:23

the upper cervical cord at the C1-C2 level

0:25

with areas of bright signal intensity

0:29

scattered within the spinal cord.

0:31

Those areas of bright signal intensity are

0:33

better seen on the T2-weighted scan, and we

0:36

see that the cord appears to be most

0:39

expanded at the C2 level.

0:42

If we pull down our T2-weighted scan,

0:46

we again see the abnormal signal intensity within

0:49

the spinal cord, and in the upper cervical region,

0:52

it does look like the cord is somewhat expanded.

0:55

So in this situation with the heterogeneous

0:58

signal intensity within the spinal cord,

1:01

we might suggest that this represents a

1:03

demyelinating disorder because it does look

1:06

like there are scattered areas within the spinal cord.

1:10

However, we're in the neoplastic category.

1:13

Fortunately,

1:14

we have the post-gadolinium enhanced scan.

1:17

As we scroll the post-gadolinium enhanced scan,

1:20

we are delighted to find that the patient has,

1:23

in addition,

1:24

a mass in the posterior fossa which appears

1:28

to be within the cerebellopontine angle cistern.

1:31

And we look on the tentorium when we see

1:34

abnormal enhancement of the tentorium,

1:36

identifying that there is a meningioma of the tentorium.

1:41

So when we have a cerebellar pontine angle cistern mass

1:44

and a mass along the tentorium

1:47

which appears to be a meningioma,

1:49

and we have a mass which is infiltrating the spinal cord,

1:53

we may come to the correct diagnosis

1:56

of Neurofibromatosis type 2.

2:00

Neurofibromatosis type 2 is associated

2:03

with ependymomas of the spinal cord.

2:06

So indeed, this patient does not have enhancing

2:10

demyelinating plaques but instead has a

2:14

diffuse ependymoma within the spinal cord,

2:17

actually potentially multifocal.

2:19

And you notice also that there is an

2:22

additional schwannoma which is associated with

2:25

the skull base here on the right side on the axial scan.

2:29

These lesions are also well-seen on

2:32

our post-gadolinium enhanced scan,

2:35

in which case we do see an additional

2:37

schwannoma within the neural foramen on the

2:40

right side at the C2 level, as well as the

2:45

areas of enhancement within the spinal cord,

2:50

representing the ependymoma.

2:52

So ependymomas typically are seen as

2:56

more well-defined lesions with the exception being ,

3:00

in those cases, of patients who

3:02

have neurofibromatosis type 2,

3:04

where the ependymoma may be multifocal.