Concluded Case

Arachnoid Cyst at Rt C3-4 level.

New case. 72 yr old,F, No known comorbidities, presentedwith neck pain rt side of neck since more than 15 yrs. .The pain is in the nape of neck and constant but at times she has severe pain also. since 1 yr she has mild difficulty in walking. She denied having any vertigo weakness of upper limbs or bowel or bladder symptoms. On exam general condition fair. Intact cranial nerves. motor system gr 4 /5 left side .DTRS hyperactive left .Dulling of sensation rt C4 dermatome..MRI done as out patient.After MRI she was ref to Neurosurgeon . Planning for elective surgery at a later date. What us the diagnosis ?

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Concluded answer
Thanks Dr Tomar and Dr Dalal for the answers. Easy case ,Neurologist and others are answering. Rare and interesting cases Neurologist and Radiologist are keeping away from the case.Any body can describe what you are seeing and then comment. We are learning from our mistakes. Diagnosis: Arachnoid cyst. Thanks Dr Tomar. MRi - A well defind T2 hyperintense ,T1 hypointense extramedullary intradural lesion noted at the Rt lateral aspect of spinal cord showing peripheral enhancement in pist contrast images.The lesion is causing significant compression over the spinal cord and displacing it left laterally and posteriorly abutting Rt existing nerve roots at C3-4. Subarachnoid fluid column is effaced at the level of lesion.
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Thanks Dr Tomar and Dr Dalal for the answers. Easy case ,Neurologist and others are answering. Rare and interesting cases Neurologist and Radiologist are keeping away from the case.Any body can describe what you are seeing and then comment. We are learning from our mistakes. Diagnosis: Arachnoid cyst. Thanks Dr Tomar. MRi - A well defind T2 hyperintense ,T1 hypointense extramedullary intradural lesion noted at the Rt lateral aspect of spinal cord showing peripheral enhancement in pist contrast images.The lesion is causing significant compression over the spinal cord and displacing it left laterally and posteriorly abutting Rt existing nerve roots at C3-4. Subarachnoid fluid column is effaced at the level of lesion.
Thank you ma'am. My pt came to me with progressive spastic paraplegia about 8 yrs after operation. What could be his treatment at this moment. He is financially unstable now after running here and there. Is there any chance his ataxia and spasticity would improve any way
Recently I saw a similar patient who came with an MRI report done 10 yrs back showing exactly similar lesion at C2. Operated, Dx Schwanoma.
Thanks for the comment. Schwannoma intradural exteamedullary lesions,you are correct. The MRI signal characteristic of Schwannoma include *T1 -- 75 % are isointense,25% are hypointense. T2--More than 95% are hyperintense,often with mixed signals. T1C+virtually 100% enhance. Please recheck all MRI sequences.
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May be Schwannoma of cervical root ? arachnoid cyst need surgical excision of tumour
Thanks for the DD Your 2nd answer is correct
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Classical id-em schwannomma
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