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Age: 61

Sex: Female

Indication: New truncal and bilateral arm numbness, right arm weakness, baseline bilateral leg weakness

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Case #14


Findings

  • Extensive T2/STIR signal hyperintensity, with areas of intensity greater than that of CSF, extending from the caudal medulla through the level of C6-C7, with areas of patchy T2/STIR signal hyperintensity in the cord inferiorly spanning C7-T3
  • Mild associated cord expansion
  • Patchy areas of associated enhancement
  • Overall mild multilevel degenerative changes with straightening of the usual cervical lordosis. Left eccentric disc osteophyte complex at C5-C6 in combination with uncovertebral spurring contributes to moderate left and mild right neural foraminal stenosis and mild spinal canal stenosis. Right eccentric disc osteophyte complex at C6-C7 in combination with uncovertebral spurring contributes to mild right neural foraminal stenosis


Diagnosis

  • Neuromyelitis optica (NMO)

Sample Report

Extensive T2/STIR signal hyperintensity extending from the caudal medulla through the level of C6-C7, with areas of patchy T2/STIR signal hyperintensity extending further inferiorly to the level of T3. Associated mild cord expansion and patchy enhancement. This appearance is most consistent with a demyelinating (particularly neuromyelitis optica spectrum disorders) or infectious process. Neoplasm is considered less likely given extent of involvement, enhancement pattern, and relatively mild associated cord expansion; however, recommend followup imaging to monitor for response to treatment.


Discussion

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Images

Longitudinally extensive cervical spinal cord lesion (red arrows) with areas of marked T2 hyperintensity equal or greater to that of CSF in this patient with neuromyelitis optica.



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