Interactive Transcript
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This was a child who had an antecedent viral infection
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and presented with lower extremity weakness and saddle
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anesthesia, effectively a cauda equina syndrome.
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The imaging of the brain was normal.
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The imaging on the non contrast scans,
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which I'll show eventually was, also normal.
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And then we got to the post gadolinium-enhanced scan.
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So on this child,
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we look at the contrast enhanced images of the cervical
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and upper thoracic region, and this is...
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I would pass this.
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This is basically normal vascularity that you see on the
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surface of the spinal cord and no enhancement
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in the spinal cord. However,
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when we get to the thoracolumbar junction,
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all of a sudden, we start seeing this enhancement on the
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surface of the conus medullaris extending
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into the cauda equina nerve roots.
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So what I'm looking at is the bright signal intensity
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enhancement on the surface of the spinal cord.
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So this is outside the spinal cord, therefore,
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intradural extramedullary.
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And then we have the cauda equina nerve roots,
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which are clumped together and are
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showing prominent enhancement.
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If we look at the axial scans through the cauda equina
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nerve roots, we see them all diffusely enhancing.
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Now, one point to be made is that the nerve roots
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do not appear to be enlarged.
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So remember
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in the past, we've seen cases of neurofibromatosis,
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in which we saw schwannomas and neurofibromas of the
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nerve roots, and that assumed an enlarged
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nerve root appearance.
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Here, in this patient who has Guillain-Barre syndrome,
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the nerve roots are not enlarged,
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but they are diffusely enhancing.
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And just to make sure that we're all agreed,
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here is the post gadolinium enhanced scan through the
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brain showing no enhancement or abnormality. On the
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spinal evaluation on T2-weighted scans,
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you're seeing flow artifacts of prominent CSF flow,
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but no abnormalities in the spinal cord, and nothing that
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can be really determined on the cauda equina nerve root
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evaluation on T2 weighted imaging.
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So this is almost a purely post gadolinium diagnosis
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that is made. In this case Guillain-Barre syndrome.
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