Intramedullary spinal metastasis
Lower limb weakness and sensory change.
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Intramedullary lumbar cord lesion at the level of T12/L1 is low T2 signal, high T2 signal with vivid near homogeneous enhancement. No significant surrounding oedema or cord expansion with some minor cord hyperintensity inferiorly.
No T2 flow voids or haemosiderin staining. Solitary lesion with no other abnormal cord or leptomeningeal enhancement.
There is a relatively long list of intramedullary spinal cord lesions but most are glial in origins such as ependymoma (60%) and astrocytomas (30%). Other non-glial tumours include haemangioblastoma as well as lymphoma, metastasis and other rarer tumours.
Based on the imaging appearances with vivid enhancement and no other distinctive imaging features the main differential is between ependymoma and metastasis. The key information is that this patient has a history of breast cancer with intracranial metastases (with similar MRI characteristics) and was being treated with steroids. This perhaps accounts for the lack of oedema that normally surrounds intramedullary metastases.