What is the most likely diagnosis for this 30-year-old male patient who had presented with neck pain and bilateral upper extremity numbness and motor weakness?
- Ependymoma
- Astrocytoma
- Schwannoma
- Meningioma
- Metastasis
Answer
Congratulations to all who selected Ependymoma. It is an intramedullary lesion, which is well-circumscribed. It is iso- to hypo-intense on T1, and hyper-intense on T2, and shows contrast enhancement. There is a hypo-intense cap sign (hemosiderin rim) which signifies associated hemorrhage. The T2-weighted image shows surrounding edema and syringomyelia.
Astrocytoma was a close differential. It is often ill-defined and not well-circumscribed, heterogenously enhances on contrast, and usually does not have associated hemorrhage.
Spinal metastasis is rarely intramedullary and is often dural-based.
Spinal schwannoma and meningioma are are extra-medullary tumors, and often show homogenous enhancement.