Neuro - Spine

Front 1

1. What are the imaging findings of diastematomyelia?
2. What associated finding may help make the dx?
3. What is diplomyelia?

Back 1

1. Complete, longitudinal division of the spinal cord into 2 hemicords. Each hemicord gives off nerve roots from its lateral aspect and each has a separate anterior spinal artery
2. Look for a bony or fibrous band between the two hemicords.
3. True duplication of the spinal cord, rare

Front 2

What is the DDX of long segment of increased T2 signal intensity w/n the cord without cord expansion?

Back 2

- Demyelinating process (MS, ADEM, Lyme Dz)
- Subacute combined degeneration (vitamin B12 def)
- Post-traumatic change
- Arterial venous malformation
- Neurosarcoidosis

Front 3

1. What is subacute combined degeneration?
2. What are the imaging findings of subacute combine degeneration?

Back 3

1. Spinal cord manifestation of vitamin B12 deficiency
2.
- Increased T2 in the posterior columns followed by the lateral spinal tracts.
- MC in cervical and upper thoracic spinal cord
- No enhancement after Gd
- No significant expansion of the spinal cord

Front 4

1. What are the most common tumors to result in drop mets?
2. What is the appearance of drop mets?

Back 4

1. Medulloblastoma, ependymoma, anaplatic glioma, germinomas, choroid plexus tumors, pineocytoma, and pineoblastoma.
2. Thickening and nodularity of the thecal sac, nerve roots, and spinal cord.

Front 5

Spinal manifestations in NF1

Back 5

- Posterior vertebral body scalloping.
- Lateral meningoceles (85%) - surgically resected.
- Short segment scoliosis.

Front 6

Spinal cord finding in Chiari I malformation

Back 6

Syringohydromyelia
- most commonly in C-spine.
- may have multiple septations within the syrinx cavity which may make shunting of the syrinx cavity difficult.

Front 7

What is the ddx of cystic presacral lesion?

Back 7

If unilocular, consider:
- epidermoid cyst
- dermoid cyst
- rectal duplication cyst
- anterior meningocele

If multilocular, consider:
- tailgut cyst: embryologic remanant of distal hindgut
- cystic lymphangioma
- sacral teratoma

Front 8

Enhancing intramedullary spinal mass

Back 8

EPENDYMOMA
- most common spinal tumor
- 2 variants: myxopapillary or cellular variants
- Myxopapillary variant: occurs in the conus medullaris, filum terminale, or cauda equina.
- Cellular variant: originates from the ependymal lining of the central canal.
- look for widening of the interpediculate distance and scalloping of the vertebral bodies.
- hemorrhage is more common than with astrocytoma
ASTROCYTOMA:
- more common in children
HEMANGIOBLASTOMA:
- neoplasms of the cord and cerebellum.
METASTATIC DISEASE:
DEMYELINATING DISEASE

Front 9

Intradural extramedullary spinal mass

Back 9

NERVE SHEATH TUMOR
- schwannomas are most common intradural extramedullary mass
MENINGIOMA
CSF METASTASES
- Hematogenous dissemination: lung and breast cancer; lymphoma
- Drop mets: anaplastic astrocytoma, GBM, medulloblastoma, ependymoma, choroid plexus tumor, and germinoma.
- Variable presentation:
solitary mass on the cord surface or at the inferior portion of the thecal sac
multiple nodular enhancing mass along the cord/nerve roots (sugarcoating)
Thickening of cauda equina.

Front 10

Abnormal signal intensity within the cord

Back 10

- Demyelination: ADEM or MS; look for T2 hyperintensity in the posterolateral aspect of the cord.
- Cord contusion
- Cord ischemia/infarct: blood supply to the cord is from the anterior spinal artery and 2 posterior spinal arteries. Ischemia/infarction involves the central gray matter of the cord.
- Intramedullary neoplasms: ependymoma vs. astrocytoma
- Transverse myelitis: non-specific myelitis which may be 2/2 infection, ischemia, autoimmune (CVD), demyelination, or paraneoplastic. Abnormal SI that affects the whole cord at that level.

Front 11

Epidural spinal mass

Back 11

DISC RELATED
- disc extrusion and sequestration
EPIDURAL HEMATOMA
- may be spontaneous or result from trauma, venous HTN, coagulopathy
- 2/2 rupture of epidural venous plexus
- most are located posteriorly.
- peripheral enhancement can be seen
EPIDURAL ABSCESS:
- MC associated with disc osteomyelitis
- most often occur anteriorly
- associated with paraspinal phlegmon or abscess formation
- may be from hematogenous dissemination of a distant infection or direct inoculation form surgical procedures or epidural anesthesia.
METASTATIC DISEASE
- contigous with the vertebral body
- pathological compression fx may be present
EPIDURAL LIPOMATOSIS
- abnormal proliferation of epidural fat most commonly seen in the T- and L- spine
- 2/2 excessive steroids or obesity
SYNOVIAL CYST
- 2.2 degenerative facet diseae.
- compress the posterolateral thecal sac.

Front 12

Prominent paraspinal flow voids

Back 12

DURAL AVF:
- Type I dural AVF: MC spinal arteriovenous shunt lesion. Direct arteriovenous connection without invening nidus.
- Branches of the anterior spinal artery communicate directly with pial veins that present as extramedullary, intradural serpentine flow voids on T2WI.
- associated with flame shaped cord edema with sparing of the periphery due to venous hypertension resulting in cord ischemia.
- On angiography, the anterior spinal artery may be seen arising from an intercostal artery. Look for a hairpin turn. Look for early filling of plexus of intradural veins.
SPINAL CORD AVM:
- present as intramedullary and extramedullary flow voids.
- may rupture and present as acute subarachnoid hemorrhage.
COLLATERAL VENOUS FLOW FROM IVC OCCLUSION:
- prominent collateral epidural or intradural veins may be seen with IVC occlusion.
SPINAL CORD NEOPLASM:
- Hemangioblastoma are commonly associated with flow voids.
- Other tumors (ependymomas, schwannomas) can also be hypervascular and contain flow voids.
CSF PULSATION:
- only seen on T2WIs.

Front 13

1. What symptoms are present in a child with tethered cord syndrome?
2. What is the normal location of the conus medullaris?
3. What is the thickness of the filum in tethered cord?
4. What associated abnormalities are seen with tethered cord?

Back 13

1. Gait disturbance, muscle weakness and atrophy, bowel or bladder dysfunction, urinary incontinence, or recurrent UTIs.
2. Conus should normally reside no lower than the body of L2. Tethered cord will demonstrate a low conus with an associated short thick filum terminale. However, the conus may be located in a normal position in tethered cord.
3. 2mm at the level of L5.
4. Lipomyelomeningocele, dermal sinus, diastematomyelia, lipoma, dermoid, and epidermoid.

Front 14

Caudal regression syndrome

Back 14

- Absence of development of a segment of the lumbar spine and/or sacrum.
- Ilia articulate with the lumbar spine (instead of the sacrum), drawing the ilia closer to the midline so that the pelvis appears narrowed.
- Spinal anomalies: low conus medullaris with tethering of the cord; anterior sacral meningocele.
- Bowel/bladder incontinence