Neuro_MR_Spine: 24 M, lower extremity weakness after surfing, enhancing central cord lesion in the lower cord with mild restric

MRI CERVICAL, THORACIC, AND LUMBAR SPINE WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 24 years of age, Male, surfing, sit up and felt back pain. Has residual weakness in legs and antalgic gait.

FINDINGS:

Evaluation of the cervical and thoracic spine is partially limited by extensive ghosting on the axial images, likely related to motion artifact.

Counting from C2, there are five lumbar type vertebral bodies. The last well-formed disc is labeled as L5-S1.

Localizer image: No visible abnormality.

Alignment: Normal.

Bone marrow: Normal for age.

Vertebrae: No significant degenerative change. The vertebral body heights are maintained.

Cord and conus: Abnormal signal and patchy enhancement of the cord from upper T11 to the level of the conus, associated with slight cord expansion predominantly involving the central gray matter. Lesion occupies at least two-thirds of the cross-sectional area of the cord. No extramedullary extension of lesion. No prominent flow voids identified to suggest enlarged venous structures. No central cord fluid signal to indicate syringohydromyelia. Spinal cord terminates at the lower L2 level.

Extra-vertebral soft tissues: Normal.

Visualized brain: Normal.

Visualized chest, abdomen, and pelvis: Normal.

Additional comment: None. 

 

IMPRESSION:

Suboptimal exam secondary to motion artifact.

1.  Abnormal intramedullary cord signal and enhancement extending from upper T11 to the level of the conus, predominantly affecting gray matter. Given the patient's history this presentation is highly concerning for surfer's myelopathy. Demyelinating disease or or spinal dural fistula (no flow voids identified) are felt to be less likely. No focal mass-like enhancement to suggest a spinal cord neoplasia.