Presentation
Numbness and muscle twitching in the right arm.
Patient Data
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An enhancing intramedullary nodule at C7 is present with extensive perilesional edema. It is an isolated lesion, with no evidence of leptomeningeal disease.
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A heterogeneous vividly enhancing nodule ( * ) is associated with extensive cord edema above and below it (green arrows). The nodule appears intramedullary with a visible 'claw sign' - cord (C) is seen wrapping around it (yellow arrows), rather than being pushed away (red arrows) as would be expected in an extramedullary mass.
This patient had had a left upper pulmonary lobe resection for small cell lung cancer 2 years ago, and had extensive metastatic disease elsewhere.
Case Discussion
This case illustrates an fairly typical appearance of intramedullary spinal cord metastatic deposit, a rare occurrence even in patients with widespread metastatic disease.