Interactive Transcript
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If we look at this patient who
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has a cauda equina syndrome,
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we note that there are markedly enlarged nerve
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roots throughout the cauda equina.
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Here we have the spinal cord coming down,
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which looks fine.
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No abnormality in the signal intensity of the spinal
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cord, but we have this thickening of the nerve roots.
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This is confirmed on the axial scans through the
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lumbosacral region, and the nerve roots are enlarged.
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Not only that,
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but we see that there are enlarged neuroforamina with
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nerve roots coming out, and once again appearing to be
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within the psoas muscle and then extending
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into the lumbosacral plexus.
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This is actually coming from the sacral neuroforamina,
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which are also markedly enlarged here.
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So in this case,
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the patient did not have contrast ordered.
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We brought the patient back later in
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the day to administer contrast.
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Why would we care about the contrast?
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Well, certainly in our differential diagnosis of things like
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subarachnoid seeding or neurofibromatosis
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or an infectious etiology, sarcoidosis,
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noninfectious inflammatory etiology,
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we would expect to see contrast enhancement.
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So the contrast enhanced study was performed.
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As you can see,
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this was done postgadolinium with fat suppression,
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fat-suppressed on the T1-weighted scan,
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and there is absolutely no enhancement of
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the nerve roots here on the axial scans.
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Although this is a little bit of dark,
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we don't see any enhancement.
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We see the enlargement of the neuroforamina and nerve
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root sleeves and the nerves out into the periphery,
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but none of them are enhancing.
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So that effectively rules out subarachnoid seeding, neurofibromatosis,
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infectious etiologies.
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This was another patient who had CIDP,
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and CIDP may or may not show contrast enhancement.
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Be careful with CIDP because often the patients will
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have at least a course of steroids for a therapy.
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And if that is administered,
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it may suppress the gadolinium enhancement
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that may occur with CIDP.
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