Transcript VONHIPPEL LINDAU DISEASE

VONHIPPEL LINDAU DISEASE
Complex cystic lesion in the conus medullaris region with
enhancing mural nodules.
Enhancing focus along thoracic cord
Intramedullary enhancing nodule in lower thoracic cord.
History: 12 year-old female with history of von Hippel
Lindau disease.
Diagnosis: von Hippel Lindau Disease with spinal
hemangioblastomas.
ACR Code: 38.3651
-- About 20% of spinal hemangioblastoma cases are associated
with von Hippel-Lindau disease
-- Hemangioblastoma accounts for about 1-15% of all cord
tumors, in which 85-90% are intramedullary.
-- MRI finding include: mural cyst (rimmed by enhancement)
flow voids (hypervascular), and signs of hemorrhage.
Rheumatoid arthritis
Soft tissue mass (pannus) appears dark on the T1-weighted
image and brighter on the T2-weighted image around the
adontoid.
History: 68-year-old female with neck pain.
Diagnosis: Rheumatoid arthritis involving the C1-2 articulation.
ACR Code: 311.711
-- About 60-70% of patients with RA develop cervical spine
symptoms sometime in the course of their disease.
-- Erosion of the dens occurs in 14-35% of patients with RA
and is a consequence of synovial inflammation in adjacent
joints.
Viral myelitis
Sagittal T1-weighted image
of the cervical spine shows
slight swelling of the cord at
C3 through C5 levels,
without abnormal signals.
Abnormal hyperintensity signals mostly involving the
grey matter of the left hemicord
History: 34 year-old female with sudden onset of left arm
weakness and sensory loss. Three months earlier she had been
treated for herpes zoster of the left upper arm and neck. EMG
showed a severe radicular lesion at the C5 and C6 level on the
left.
Diagnosis: Varicella-Zoster viral myelitis.
ACR Code:
-- Herpes zoster represents a reactivation of latent varicella zoster
virus (VZV) infection. Compromised immunity status increases
the likelihood of VZV reactivation .
-- Myelitis is a rare complication of herpes zoster, which can be
diagnosed based on the close temporal relationship between the
onset of skin lesions and myelitis.
-- The virus can cause direct viral invasion of the cord, vasculitis
with ischaemic necrosis, or via an immunological-parainfectious
mechanism.
MRI findings in documented cases of VZV myelitis include:
-- diffuse hyperintensity on T2-weighted images that extends over
several levels representingedema;
-- focal or multifocal enhancement on post-contrast T1-weighted
images representing direct viral invasion or blood-cord barrier
breakdown.
-- there can be cord swelling.