Interactive Transcript
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This was a gentleman who was complaining
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about neck pain.
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And we did this study initially without
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contrast. On the scans that you see,
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we noticed that there's relatively little in
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the way of degenerative changes in the
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cervical spine. On the axial scans, again,
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not much was identified. However,
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the patient had evidence of prior surgery.
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And so for that reason, we gave gadolinium.
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On the post-gadolinium-enhanced scan,
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we saw areas of contrast enhancement on the
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posterior surface of the spinal cord in
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the intradural extramedullary space.
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So here we see one of the lesions at
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the cervicomedullary junction.
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Here we see another lesion on the
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surface of the spinal cord.
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And if I move the image up a little bit more,
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down here, we also were worried
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about some of the areas
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of enhancement at the cervicothoracic
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junction, as far as these enhancing nodules.
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I'm just going to try to magnify that as well
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and move this around so you could see
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this a little bit better down here.
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And this was our area of concern.
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When we performed the axial scans,
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we again saw areas of concern that were within
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the thecal sac but outside the spinal cord.
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So, intradural extramedullary.
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And we had one large nodule here,
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which was at that cervicomedullary junction.
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And then here,
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as we approached the thoracic region,
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we had small areas of enhancement, as well.
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So we started to go through a differential diagnosis.
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And when you see multiple nodules of
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enhancement on the surface of the spinal cord,
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we were most worried about things like
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subarachnoid seeding as the most common thing
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that would occur here. And in addition,
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we were concerned about something that might
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be infectious on the surface of the spinal cord.
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However, fortunately, we did include portion of the
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cerebellum in the scan.
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And as we go to the top of the scan,
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you'll notice that there is another lesion in the
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cerebellum that's faintly seen on
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the topmost scan. Of course,
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the clinicians hadn't given us any history
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about the previous surgery for this patient.
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And the only history we had was neck pain.
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This patient had had a previous
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hemangioblastoma resected from the cerebellum,
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had an additional hemangioblastoma.
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And this was a patient with Von Hippel Lindau
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disease with multiple intradural extramedullary
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hemangioblastomas throughout the cervical
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and cervicothoracic junction.
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When we proceeded to scan a little bit
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more superiorly into the brain,
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we identified more clearly that
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enhancing mass. And of course,
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there were additional ones.
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When you have a patient who has hemangioblastomas,
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I just want to remind you to look at two other areas
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of the anatomy that are important in patients
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with hemangioblastomas and Von Hippel Lindau
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disease. That is the temporal bone,
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because you can get endolymphatic sac tumors
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of the temporal bone in patients with
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Von Hippel Lindau disease. And additionally,
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you want to look at the retina,
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because retinal hemangioblastomas or retinal
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angiomas can occur in association with
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Von Hippel Lindau disease, as well.
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So any little focal area of enhancement,
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as you see here along the posterior
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margin of the globe,
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you want to consider the possibility of
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a retinal angioma associated with Von Hippel Lindau.
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Of course, in the abdomen,
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you would be worried about the renal cell
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carcinomas and pancreatic lesions.
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So an example of multiple intradural
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extramedullary hemangioblastomas in a patient
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with Von Hippel Lindau disease and
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cerebellar hemangioblastomas.
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