Radiation myelitis

Case contributed by Anastasiya Bohdan
Diagnosis almost certain

Presentation

A patient presented with progressive paresthesia and central paraparesis of lower limbs. She had a Hodgkin lymphoma treated with radiotherapy 5 months before disease onset.

Patient Data

Age: 30 years
Gender: Female

Cervical spine

mri

The cervical cord is expanded from C4 to C6 and demonstrates a T2 hyperintense and T1 isointense lesion. It involves lateral cord structures. The intramedullary lesion demonstrates peripheral contrast enhancement. Cervical vertebrae are unremarkable other than demonstrating uniform fatty bone marrow in keeping with prior radiotherapy.

Incompletely imaged superior mediastinal mass. 

Cervical spine - after 4 month

mri

A Follow-up study demonstrates cord edema expansion from C1 to T3, as well as increasing contrast enhancement. Increased T1 marrow signal of the vertebrae is again present in keeping with radiation-induced fatty marrow replacement.

Incompletely imaged superior mediastinal mass. 

Case Discussion

CSF studies were conducted after clinical manifestation. These results excluded lymphoma and myelitis.

Cervical vertebrae fatty marrow replacement due to radiation. The diagnosis is therefore most likely acute radiation myelopathy.

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