Interactive Transcript
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This is another patient who presented with low
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back pain but had an element of fecal and
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urinary incontinence associated with it.
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We have the T1-weighted scan to the left,
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the T2-weighted scan centrally,
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and the STIR image on the right-hand side.
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It's pretty clear that we have this mass that
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is centered at the L1-L2 disc level.
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We would describe this lesion as being intradural
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extramedullary because it does indeed have
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that meniscus sign of CSF above and below it.
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That is the widening of the CSF space.
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We also know that this is intradural extramedullary
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because we are at a level where we
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are below the spinal cord termination,
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generally at the L1 level or L2 level,
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and therefore this is going to be in
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the intradural extramedullary space.
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This is a purely solid lesion.
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In this location,
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we have a differential diagnosis which would
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include either a meningioma or a schwannoma.
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But just looking at the numbers in the lumbar
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level, schwannomas outnumber Meningiomas,
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this lesion does have a basis that it is along
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the posterior dura and therefore it could have
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arised from this posterior dura and could be a
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meningioma. Let's look at the axial scans.
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I'm just going to window these a little
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bit better for the audience.
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And here we have the mass on the T2-weighted
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axial scan. And it is, as you can see,
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intradural within the thecal sac,
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but outside the spinal cord,
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which is demonstrated above the lesion.
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So here's the termination of the spinal cord,
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the so called conus medullaris,
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and then we rise with this mass.
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So the post-gadolinium-enhanced scans,
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which were not performed since this was
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done as a DJD low back pain protocol,
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might help us in distinguishing between a
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schwannoma versus a meningioma, in that
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meningiomas tend to have a dural
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based tail as opposed to schwannomas,
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which do not have that dural enhancement
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associated with it. In this case,
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just based on the numbers,
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we would say schwannoma favored over meningioma.
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Recommend gadolinium-enhanced pulse sequences
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for further evaluation.
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