Spinal schwannoma

Case contributed by Dr Ian Bickle

Presentation

Ongoing right L4 radiculopathy. Otherwise well.

Patient Data

Age: 50 years
Gender: Female
MRI

Relatively subtle T1 isointense, T2 hyperintense lesion at the L3 vertebral body level in the central canal, which enhances avidly following contrast.

The relatively subtle findings on non-contrast sequences become obvious following contrast. The nature and relationship to the cauda equina and nerve roots are very well delineated on the post-gad sequences. 

Case Discussion

Incidental finding of a intrathecal, extramedullary mass.  The differential includes; schwannoma, neurofibroma or a metastasis. The former is in the most likely in this case, given the imaging characteristics.  Note the similarity in appearances, especially on the post contrast sequences to a schwannoma at the IAM - avidly enhancing with small cystic areas of degeneration within.

The appearances were static on a repeat scan 5 months later.

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