Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

The posterior reversible encephalopathy syndrome [PRES] is characterized by patchy cortical and subcortical lesions in the distribution of the posterior circulation. The lesions are classically reversible. This syndrome has multiple etiologies, most of which cause acute hypertension. We present a case of PRES with involvement of the medulla and cervical cord [apart from the typical parieto-occipital lesions]-an extremely rare imaging manifestation of PRES. It is important to recognize the imaging findings of PRES in spinal cord, and avoid misdiagnosis as myelitis by proper clinical correlation. Typically patients with myelitis have a profound neurodeficit, while patients with spinal manifestations of PRES are asymptomatic. Involvement of the cord in PRES has probably been an underrecognized entity as spinal imaging is not routinely performed in posterior reversible encephalopathy syndrome

Intramedullary cysticercosis.

A 42-year-old soldier, a known case of cerebral parenchymal neurocysticercosis presented with insidious onset gradually progressive weakness of both lower limbs for six months. Investigations revealed an intramedullary cyst in the cervicodorsal region. Following surgical excision of an intramedullary cysticercus cyst, the patient showed recovery in his neurological deficits.

Primary spinal intramedullary primitive neuroectodermal tumour in an adult

Primary spinal primitive neuroectodermal tumour [PNET] is believed to be very rare. A review of the available literature revealed 14 cases of spinal PNET, which affected the paediatric age group but no previously reported cases involved an adult. A 42-year-old patient presented with weakness of both lower limbs and signs of upper motor neuron lesion. Intramedullary PNET was discovered after neurological deterioration following C3-4, C5-6 and C6-7 discectomy. Patient received postoperative radiotherapy, however, he died 8 months later from brain metastasis. As this is the first case of its kind in the literature, we believe it is worth reporting to point out the possibility of the existence of such a lesion in the spinal cord

Extramedullary involvement in acute lymphoblastic leukemia and its relation to therapy.

Extramedullary involvement (EMI) of various body sites was studied by doing CSF cytology anu FNAC of testes and lymph nodes in 82 children with acute lymphoblastic leukemia (ALL). Forty-five patients had received no therapy (group I) and 37 had been diagnosed and treated earlier and were now in remission (36) or relapse (group II). EMI was documented in 48.9% and 32.4% of patients of group I and II respectively. EMI was seen more frequently in patients with FAB-L 2 subtype (66.6%) as compared to FAB-L1 subtype (34.6%) in group I. Lymph nodes and testes were commonly involved in group I and II patients respectively. Successful remission after complete chemotherapy was achieved in 82.5% of group I patients. However, successful remission rates were 95.2% in patients without any evidence of EMI versus 68.4% in those with EMI. These differences were also observed when response to therapy was analysed separately for patients with FAB-L1 and FAB-L2 subtypes.