Concluded Case

Intramedullary mass with hydrosalpinx

New case 42 yr ,M ,Maldivian, presented with pain and parasthesia let upper limbs since 1 yr.Difficuly to hold thongs with the left hand especially carrying more than a kg wt. Denied having any neck pain. Pain is diffuse from left shoulder down ,mild in nature but more when he take heavy objects. Non radicular pain in the form of dull aching type. Numbness is mainly in the forearm and palm ,mild only with out any diurnal variation.He did not noticed any sensory dysfunction . He has no problem with rt upper limb,no difficulty in walking, no bowel or bladder symptoms. He stated that he had undergone some neck surgery during 2017 but no details available. On exam- vitals stable. Intact cranial nerves. mild wasting of small muscles of left hand and forearm. Dtrs left biceps ,triceps supinator elicitable only on reinforcement. Dulling of sensation C6,7,8,T1 left side. Rest of the neurological exam were normal. What abnormality in the MRI spine with further management?

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Concluded answer

Thanks Dr Jason MRI spine: C5-6,C6-7 : disc osteophyte complex with moderate bulge and pisterocentral and bilateral foraminal protrusion directly indenting and mild compression at the anterior margin of the spinal cord and exiting nerve roots on both sides left more than rt. * Small to moderate sized ill defind area of ontramedullary abnormal enhancement wiylthbin the cordat the level od D1 & D2 vertebral bodies with mass effect in the form of compression of the central canal with proximal dialatation suggestive of hydrosalpinx most likely to neoclassical etiology. Seen by the Neurosurgeon, suggested repeat MRI 3 to 6 months.

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Thanks Dr Jason MRI spine: C5-6,C6-7 : disc osteophyte complex with moderate bulge and pisterocentral and bilateral foraminal protrusion directly indenting and mild compression at the anterior margin of the spinal cord and exiting nerve roots on both sides left more than rt. * Small to moderate sized ill defind area of ontramedullary abnormal enhancement wiylthbin the cordat the level od D1 & D2 vertebral bodies with mass effect in the form of compression of the central canal with proximal dialatation suggestive of hydrosalpinx most likely to neoclassical etiology. Seen by the Neurosurgeon, suggested repeat MRI 3 to 6 months.

thinned cord with hyper intense t2 signal within suggests myelomalacia... appears post myelitic.. not syrinx

Syrinx extending from C1 to C7

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