Radiation-induced myelitis of the medulla oblongata and the cervical cord with bone marrow signal changes

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Left sided weakness and hemiparesis. History of nasopharyngeal carcinoma post-radiotherapy.

Patient Data

Age: 52 years
Gender: Male

Subtle hypodensity of the medulla oblongata. The rest of the study is unremarkable. 

The medulla oblongata as well as the cervicomedullary junction, cervical and scanned upper dorsal cord is grossly enlarged with diffusely hyperintense T2 and FLAIR signal intensity as well as mildly hypointense T1 signal with some restricted diffusion and mild heterogeneous post-contrast enhancement. 

The clivus and the skull base as well as the scanned cervical and upper dorsal bony spine show fatty infiltration with hyperintense T1 and T2 signal intensity.  

No nasopharyngeal mass lesions.

Normal size and configuration of the ventricular system. 

No supratentorial mass lesions or definite parenchymal areas of abnormal signal intensity. 

Normal cortical sulci with no extra-axial collection.  

Normal cerebellum.  

Bilateral otomastoiditis with T2 prolongation as well as mild ethmoidal and sphneoidal sinusitis.  

Case Discussion

Post irradiation demyelination and myelitis of the medulla oblongata, cervicomedullary junction as well as the cervical and scanned upper dorsal cord with post-irradiational fatty marrow changes of the clivus, skull base and the cervicodorsal spine. 

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Case Information

rID: 38575
Case created: 26th Jul 2015
Last edited: 24th Apr 2017
Inclusion in quiz mode: Included

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