Left torticollis, bilateral lower limb paraparesis. Right-sided weakness and stridor for one month duration.
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Spinal MRI sagittal and axial images show an ill-defined intra-medullary lesion occupying the cervical and thoracic parts of the spinal cord and causing expansion of the cord. It shows iso to low intense signal on T1, high intense signal on T2 with small cystic component distally. No hemorrhagic component. The lesion shows peripheral enhancement on post contrast images.
Axial T2 of brain shows no abnormal signal.
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Spinal astrocytoma is more common in children, sometimes affects the whole spine. The main differential is ependymoma, which can show hemorrhagic component and more usually show cystic component.
This case was proved by pathology to be low-grade glioma compatible with pilocytic astrocytoma (WHO grade 1). Immunostains show the following results: GFAP: positive, KI67: low.