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This was a young adult patient who presented

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with myelopathy with tingling and paresthesias

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in the upper extremities.

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Here we have a sagittal T2-weighted,

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a sagittal STIR and a post-gadolinium enhanced scan.

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What we see is a focal lesion

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within the spinal cord.

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We note that the CSF space narrows at the

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level of the spinal cord, identifying it as an

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intradural intramedullary lesion which has mass effect.

0:29

Again, narrowing of the CSF space

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at the border with the mass.

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This mass is small in size and relatively well defined.

0:39

Again, we get that sense of the expansion of the

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spinal cord on the T2-weighted and the STIR image.

0:47

On post-gadolinium enhanced scan,

0:49

we do see focal enhancement.

0:51

This more focal lesion that is relatively

0:56

confined to a small area in the spinal cord

0:59

is most in keeping with an ependymoma of the spinal cord.

1:04

Astrocytomas, by and large, are more diffuse,

1:08

elongated lesions, whereas ependymomas may

1:11

be small in size and well-defined.

1:15

Another of the features that we look for with

1:17

ependymomas is the so-called hemosiderin cap sign.

1:21

And that is that the ependymomas

1:23

sometimes will show hemorrhage.

1:24

And what you might see is a little rim of dark

1:27

signal intensity at the edge of the lesion,

1:30

which may be that edge of hemosiderin that

1:34

is associated with the cord lesion.

1:36

In this case,

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the lesion shows contrast enhancement and that is

1:40

typical of nearly all of the neoplasms

1:43

that occur within the spinal cord.