Metastatic disease to the spine: intramedullary and extradural compression
Presents with quadriplegia. Past history of carcinoid tumour.
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Mass lesions in the upper cervical cord with restricted diffusion consistent with metastases associated with extrinsic compression by extradural masses at the level of the C3 vertebra and in the upper thoracic spine.
Intraparenchymal cord metastases are unusual but should be considered in patients with disseminated malignancy. Note the restricted diffusion in these cord lesions due to the packed nature of the cytoplasm within malignant cells (higher nucleus to cytoplasm ratio compared with normal cells) and the trapping of water molecules in the interspaces between cells.