Bilateral lower limb weakness and paresthesia.
MRI cervical spine
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An oval shaped well-circumscribed right anterior intramedullary lesion is noted opposite C7 and T1 vertebral bodies forming smooth focal bulge. It exhibits peripheral hemosiderin induced signal loss at all pulse sequences with internal heterogeneous signal "popcorn like" and blooming in SWI. No significant post contrast enhancement.
This is associated with linear T2 hypointensity through the central canal of the spinal cord proximal to the lesion till CV4/5 level and distally down to DV2/3 level continuous with the peripheral hypointense rim of the lesion mostly representing hemosiderin.
The imaging features are suggestive of spinal cavernoma with characteristics "popcorn" appearance and hemosidrin cap on T2WI. Spinal cavernoma (Spinal cord cavernous malformations) is a rare vascular malformation intramedullary lesion of the spinal cord. The main differential is that of a spinal ependymoma which shows post contrast enhancement unlike cavernoma.