Spontaneous Herniation of the Thoracic Spinal Cord: A Case Report

Spontaneous herniation of the spinal cord is a rare disease entity in which spinal cord substance is herniated through a previously uninjured and/or untouched dura. It is a cause of myelopathy that is treatable but difficult to diagnose. We report the CT and MR findings of a case of spontaneous thoracic spinal cord herniation manifesting as ventrolateral protrusion of thoracic spinal cord through a dural defect.

Ganglion Cyst in the Lumbar Anterior Epidural Space: A Case Report

A ganglion cyst is a tumor-like lesion that contains mucous or myxoid material in the fibrous capsule. We report a case of ganglion cyst located in the lumbar anterior epidural space and causing lumbar radiculopathy. Computed tomography and magnetic resonance imaging revealed the cyst as a cystic lesion with wall en-hancement. Myelography showed that it was not filled with contrast medium and not connected with the dura, nerve root, or facet joint.

Pituitary Adenoma with Extensive Calcifications Mimicking Craniopharyngioma: A Case Report

A 27 year old man presented with complaints of headache and visual disturbance, first noted six months earlier. Simple radiographs of skull sellar widening and calcification. Brain CT revealed a 3 X3 X4 cm-sized sellar suprasellar mass with heavy calcification. T1-weighted MR images showed that the signal intensity of the mass was slightly lower than that of the gray matter, while T2-weighted images showed heterogeneous high signal intensity with central low-signal-intensity foci, suggesting calcification After contrast infusion, enhancement was irregular. Surgery revealed a 4 X5 cm sized, well-demarcated, lobulated mass adhering to the meninges. Papillary-type pituitary adenoma was histologically confirmed. We report the CT and MR findings of atypical pituitary adenoma with extensive internal calcification mimicking craniopharyngioma.

Atypical Pituitary Macroadenoma: A case report

A 34-year-old man who for two months had experienced headaches and blurred vision showed a 6x5x4cm-sized sellar and suprasellar mass with mainly cystic and partially solid portions on both brain CT and MRI. Peripheral, rim-like calcification of the cystic mass was clearly visible on non-enhanced CT and pituitary acidophil stem celladenoma was confirmed. This is an immature neoplasm which is shown by immunohistochemical study and electromicrocopy to be derived from the common progenitor of growth hormone and prolactin cells. We recently encountered one case, involving unusual radiographic findings, in which pituitary macroadenoma mimicked craniopharyngioma, and we report the CT and MR findings of this tumor.

Multiple Bone Metastasis of Medulloblastoma: A Case Report

Medulloblastoma is one of the most undifferentiated primitive neuroectodermal tumors and represents about 30% of all posterior fossa tumors in children. Disseminated medulloblastoma, mainly involving cerebral surfaces, ventricles and the subarachnoid space can, in 50% of patients, be identified on intial imaging studies. One thirdof these lesions metastasize to an extracranial site, primarily to bone. Osseous metastases, which occur mainly after craniectomy are typically lytic, but osteoblastic lesions also may occur. We experienced the case of a 14year-old female patient with multiple bone metastases of medulloblastoma after craniectomy. Bone metastaticlesions were present in the right femur and thoracic spine and were osteoblastic or osteolytic

Multiple Metastases of Paraganglioma: A case report

Paragangliomas of the carotid body are rare tumors, usually regarded as benign. We report a case of multiple metastases from a paraganglioma which occurred in a 34-year-old man. Paraganglioma, which has originated two years previously in the right carotid body, was diagnosed. We performed neck and thoracic spine MRI, whole body bone scan, and neck and thoracic spinal angiography revealed multiple metastatic lesions in cervical lymph nodes, spines, ribs, and ilia. Metastatic lesions showed hypervascularity similar to that of a primary tumor.

Clinical and MR Findings of Tethered Cord Syndrome

PURPOSE: Tethered cord syndrome(TCS) is defined as low position of the conus medullaris by the abnormally fixed spinal cord with progressive neurologic deficit MATERIALS AND METHODS: To evaluate the findings of TCS at MRI and its diagnostic value, we performed a retrospective analysis of MRI of 30 patients with emphasis on clinical manifestation, level of conus medullaris, cause of tethering, and associated findings. RESULTS: Clinical presentation included back mass(26 cases), neurogenic bladder(5 cases), urinary incontinence(5 cases), progressive constipation(2 cases), skin dimpling(1 case), gait disturbance(1 case) and club foot (1 case). Neurologic deficit was developed in 11 cases(40% and mean age of these patients at the time of diagnosis was 8.6 years. The most common cause of tethering was lipoma(63%). The tips of conus medullaris were below the level of the second lumbar spine in all patients. The causes of tethering were lipomatous component(spinal lipoma and lipomyelomenigocele) in 67% myelomeningocele in 20%, presacral mass in 7%, thickened filum terminale in 3% and postoperative change in 3%. Associated anomalies included syringomyelia(20%) and hydrocephalus was associated in 3 out of 5 patients who underwent brain MRI. CONCLUSION: MRI clearly delineated the location of conus, tethering of the filum terminale with their causes and associated abnormalities. MRI examination is a very useful diagnostic tool for the early evaluation of TCS and the postoperative follow up.

Determination of main feeding artery with CT findings in cases of ruptured aneurysm of anterior communicating artery

Rupture of anterior communicating artery aneurysm is one of the most important casuses of subarachnoid hemorrhage. Subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm shows characteristic CT findings, such as forntal hematoma or septum pellucidum hematoma. In some patients with the ruptured aneurysm, direct carotid angiography may be needed. particularly when transfemoral approach is not possible. However, not much have been known about the puncture site selection between the two carotid arteries in relation to the location of hematoma in CT scans. To determine the ideal puncture site of the direct carotid angiography, seventy-five cases of anterior communicating artery aneurysm confirmed by operation from May 1988 to April 1992, were analyzed in terms of relationship between location of hematoma on CT, direction of aneurysm and A1 artery on angiograms. Frontal lobar hematoma was more prevalent than septal hematoma, and was more common on the right side. In cases of lobar hematoma, aneurysm was directed to the ipsilateral side of the hematoma (67%) and was most commonly fed by contralateral A1 artery(75%). Septal bematoma consisted 36% of the cases and among there, midline directed aneurysm was most common, frequently fed by left A1 artery. In conclusion, when performing direct carotid angiography in patients with anterior communicating artery aneurysm, if forntal hematoma is observed on CT, it may be beneficial to puncture contralateral carotid artery. Meanwhile, if hemorrhage of septum pellucidum is observed, it may be better to puncture left carotid artery.