Interactive Transcript
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This was a woman who was complaining about
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paresthesias in both the upper extremities,
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as well as the lower extremity.
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And the patient was requested for complete
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spine evaluation, as well as the brain.
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The brain was unremarkable. On the spinal
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images, we have the T1-weighted scan,
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the STIR image in the center,
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and the T2-weighted scan.
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On the initial evaluation,
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it was a little bit peculiar in that the
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spinal cord seemed to have an unusual contour
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and was tented posteriorly in one location in
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the mid thoracic region. But in general,
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not much was suspected.
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And when we did the axial T2-weighted
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scans through the spinal cord, again,
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there were some unusual contour features of
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the spinal cord, in that it was a little bit
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flattened in some areas and had a funny shape to it,
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but we really weren't suspecting all that much.
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We thought maybe this was arachnoidal
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adhesions, possibly from lumbar puncture.
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And we went through this scan and said, you know, well,
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not looking too much, you know,
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maybe from, you know, previous instrumentation
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and arachnoid adhesions.
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And then we came to the post-gadolinium
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enhanced images. Wow.
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So here you see, on the surface of the
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spinal cord contrast enhancement,
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both anteriorly as well as posteriorly in the
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cervical region. In the thoracic region,
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that tenting that we described previously,
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you can see, again posteriorly,
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but there are little nodules of enhancement in
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addition to sort of sugar coating of the
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spinal cord with contrast enhancement.
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And then in the lumbar region,
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we see very thick enhancement of the cauda equina
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nerve roots throughout the lumbar
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region. So going back through the history,
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this patient turned out had breast cancer.
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So this is an example of subarachnoid seeding
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in a woman who has had breast cancer, in which
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there is both sugar coating or candle
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guttering of the spinal cord,
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as well as more focal nodularity leading to
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the scarring and tenting of the
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spinal cord posteriorly,
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as well as cauda equina nerve root seeding.
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And this was the abnormality that was
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accounting for the patient's upper and lower
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extremity paresthesias. Once again,
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in this situation,
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I would recommend scanning the brain and
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making sure that there is not a parenchymal
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enhancement in the brain that could be the
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source for the subarachnoid seeding.
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Because parenchymal lesions that shed in the CSF are a
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more common source of subarachnoid seeding
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in breast cancer than de novo
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seeding of the subarachnoid space
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without a parenchymal lesion.
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