Concluded Case

Intradural extramedullary Meningioma D9 to D12

New case. 47 yr ,F, Todays 1st OPD case. Presented with low back pain 7 yrs ,progressive parasthesia both lower limbs 2 months,buckling of the knees while walking occasionally for 2 weeks. Insedous onset and progressive low back pain for 7 yrs . Look lot of treatment. Pain aggravated since 4 months and took ayurvedic treatment including back and leg message for 2 months. After that developed parasthesia both legs and since 2 weeks whole walking there is tendency to fall due to buckling of left knee. Denied having any blower or bladder dysfunction. MRI done before reported to have disc lesion. Past history - No trauma to the back. No known medical illness. On exam vitals stable. BP 130/ 80 mmhg.Intact cranial nerves and upper limbs.Mormal abdominal muscles Mid adductor spasticity left side. Lower limbs gr5/5 power. DTRs bilsteral hyperactive kneejerks,ankle jerks normal with O plantars bilaterally.Dulling of sensations below D12 Rt side.( Pt is from the neighboring state making mistake for sensory exam in the OPD). An urgent MRI Dorsal spine done. What is the diagnosis? After seeing the MRI ,she is ref to Neurosurgeon and waiting to see the Neurosurgeon

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Thanks for the answeres. Thanks Dr Riju and Dr Prveen for the correct answers. MRI dorsal spine shows I'll defind intradural extramedullary lesion,along the left posterolateral aspect of dorsal spinal canal measuring ( 65(cc )×17 (TR)×13(AP) mm,extending to D9 toD12 vertebral body level.Lesion is broad based against the left posterolateral due matter and shows homogeneous enhancement. Lesion is compressing the spinal cord,which is displaced anterilaterally to the RT.No altered signal with in the cord. Imp: Features suggestive of meningioma. Seen by the Neurosurgeon,surgery fixed on 16th November as per the request of the patient.

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An intra dural - extramedullary spinal coed tumour of dorsal spine with cord compression. There is homogeneous intensity with dural involvement indicative of dural tail sign - Also seen is Gingko - leaf sign - suggestive of Spinal cord meningioma . A neurosurgical excision of the tumour is indicated and rightly referred to neurosurgeon

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Thanks for the answeres. Thanks Dr Riju and Dr Prveen for the correct answers. MRI dorsal spine shows I'll defind intradural extramedullary lesion,along the left posterolateral aspect of dorsal spinal canal measuring ( 65(cc )×17 (TR)×13(AP) mm,extending to D9 toD12 vertebral body level.Lesion is broad based against the left posterolateral due matter and shows homogeneous enhancement. Lesion is compressing the spinal cord,which is displaced anterilaterally to the RT.No altered signal with in the cord. Imp: Features suggestive of meningioma. Seen by the Neurosurgeon,surgery fixed on 16th November as per the request of the patient.

Definitely mass seen in l3 region Opinion of orthopedic or neurosurgeon Biopsy laproscopic HP EMG Sos mri brain

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Look like an intradural extramedullary lesion with cord compression Need excision Neurosurgery evaluation

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