Presentation
Chronic neck pain with left sided radiculopathy. The patient is unable to sleep at night due to the pain.
Patient Data
An intradural extramedullary lesion positioned at the craniocervical junction is observed. The lesion occupies the left anterior aspect of the causing posterolateral mass effect on the medulla and proximal spinal cord. The lesion demonstrates homogeneous increased signal intensity on T2 and iso-signal intensity on T1 compared to adjacent spinal cord, with an equivocal dural tail at the inferior portion of the lesion. It measures 1.9 x 1.1 cm in its greatest craniocaudal and anterior to posterior dimensions. There is no associated extradural extension or myelopathic changes within the brainstem/spinal cord.
Background of arthrosis and discogenic changes throughout the remainder of the cervical spine.
Case Discussion
Without biopsy or contrast imaging a few intradural extramedullary lesions could be entertained as a differential diagnosis with meningioma being most likely overall.
Meningiomas are WHO grade 1-3 lesions that most commonly arise supratentorially and demonstrate a dural tail on post contrast imaging.