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Intramedullary lipoma

Findings

Figure 1: Intramedullary mass at the T9-T10 level with hyperintense signal on T1-weighted sequence.
Figure 2: Intramedullary mass at the T9-T10 level with hyperintense signal on the T2 -weighted sequence.
Figure 3: Fat suppression on the STIR image.
Figure 4 and Figure 5: Fat saturation on the T1 fat saturated post contrast images and no enhancement of the lesion. There also is splaying of the spinal cord at this level.


Diagnosis: Intramedullary lipoma (surgically proven)


99% of intramedullary lipomas are associated with spinal dysraphism. Most tumors occur in the dorsal cervical and thoracic cord.

Intramedullary lipomas are rare. These comprise 1-2 % of intramedullary tumors. Multiple noncontiguous intramedullary lipomas are even rarer. These affect both sexes equally. Most patients present with symptoms during the first 2 -3 decades of life. Most have a slow progression of neurological deterioration. Sensory disturbances, pain, ataxia and lower extremity weakness are the most common presenting complaints. Urinary and bowel incontinence present later. CT can show a fatty lesion and MRI is diagnostic. They have a short T1 relaxation time and are bright on T1 weighted images and also bright on T2 weighted images following signal intensity of subcutaneous fat. There is very little enhancement. Treatment is still controversial and some physicians advocate early decompression before onset of symptoms because of significant residual deficits after surgery in symptomatic patients. Complete resection is not possible in intramedullary lipomas.

Symptomatic Bipartite Patella- MRI & CT

It is a common congenital fragmentation or synchondrosis of the patella. It occurs in approximately 1% of population but some have observed a much higher incidence; most remain asymptomatic, but direct trauma may disrupt the synchondroses, causing symtoms that mimic those of fracture. Symptomatic cases are identified on MRI with marrow edema as in our case of a 11 yr old with pain for last 6 months. Second opinion- Teleradiology Providers

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Subependymal giant cell astrocytoma

Findings

Axial T2 weighted image demonstrates a well-marginated intraventricular mass near the foramen of Monro. The lesion is lobulated in appearance and is causing obstructive hydrocephalus. Associated vasogenic edema is noted extending into the left frontal lobe. Axial and Coronal T1 contrast-enhanced MR sequences demonstrate intense, heterogeneous enhancement of the mass.

Differential diagnosis:
- Astrocytoma
- Subependymoma
- Germinoma
- Choroid plexus tumor
- Hamartoma


Diagnosis: Subependymal giant cell astrocytoma


Key points

Subependymal giant cell astrocytomas are seen as an enhancing intraventricular mass in a patient with tuberous sclerosis complex. Subependymal giant cell astrocytomas occur in about 10 percent of patients with TS.
Almost always located near the foramen of Monro.
Well marginated, often lobulated
Heterogeneous, strong enhancement
Growth favors the diagnosis (vs static tuber).
Brain MR with contrast should be recommended every 1-2 years for followup.
FLAIR sequence is useful for detecting subtle CNS findings of tuberous sclerosis.
SGCTs are pathologically indistinguishable from subependymal nodules, and radiologic criteria for distinguishing the lesions are unreliable. Clinical criteria are therefore more useful in decision-making regarding operative therapy.

Suspected Artery of Percheron Infarct-Rare Case Report

Thalami and midbrain arterial supply arises from many perforating blood vessels with a complex distribution for which many variations have been described. One rare variation, named the “artery of Percheron,” is a solitary arterial trunk that arises from one of the proximal
segments of a posterior cerebral artery and supplies the paramedian thalami and the rostral midbrain bilaterally. Occlusion of this artery results in bilateral thalamic and mesencephalic infarctions. This is a 50 year old female who developed sudden altered sensorium following hypotension due to sorbitrate administration. Similar cases have been described in AJNR Am J Neuroradiol 24:2005–2008, November/December 2003. Diffusion and FLAIR images of the case have been provided showing FLAIR hyperintensity and differential bright signal on DWI.

Case Submitted by Dr Sangeeta Aneja, MD, Associate Professor & Head, Department of Radiodiagnosis, L.L.R.M. Medical College, Meerut.

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