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Neurorad -Neuropath Conference

Neurorad -Neuropath Conference. April 2013 Stephen Bagg, MD Neuroradiology Fellow, UNC. Case 1. 41 y/o male 18 months of progressive back pain radiating down right leg No significant past medical history. Tanycytic ependymoma. Ependymal tumors include the following:

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Neurorad -Neuropath Conference

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  1. Neurorad-Neuropath Conference April 2013 Stephen Bagg, MD Neuroradiology Fellow, UNC

  2. Case 1 • 41 y/o male • 18 months of progressive back pain radiating down right leg • No significant past medical history

  3. Tanycyticependymoma • Ependymal tumors include the following: • -Subependymoma, WHO grade I • -Myxopapillaryependymoma, WHO grade I • -Ependymomas(cellular, papillary, clear cell, tanycyticvariants), WHO II grade II • -Anaplastic ependymoma, WHO grade III • Tanycytes are interspersed among the more common columnar-shaped ependymal cells in the floor of the third ventricle, some of the circumventricular organs such as the hypophysis, pineal gland, subcommisural organ, area postrema and organumvasculosum of the lamina terminalis. Tanycytes are distinguished by a long nonbranching cytoplasmic process that extends into the neuropil to the surface of blood vessels and neurons. (“Tanycyte” is derived from the Greek word meaning to “stretch”.) • 65% of tanycyticependymomas are in spinal cord, but rarely caudaequina. They are circumscribed and usually have a good prognosis. Tosun O, et al. Spinal tanycyticependymoma with diffusion restriction on MRI. ActaNeurologicaBelgica. 112:77-80, 2012. Radhakrishnan N, et al. Tanycyticependymoma of filumterminale: A case report. Clinical Neurology and Neurosurgery 114 (2012) 169– 171.

  4. Case 2 • 61 y/o female • Left lower extremity pain • Remaining history noncontributory

  5. T2 T2 STIR T1 no Gad T1 post Gad

  6. T2 T1 no Gad T1 Post Gd

  7. Hemangioblastoma

  8. Primary intramedullary tumors of the spinal cord Karikari I, et al. Impact of Tumor Histology on Resectabilityand Neurological Outcome in Primary Intramedullary Spinal Cord Tumors:A Single-Center Experience With 102 Patients. Neurosurgery 68:188–197, 2011

  9. Case 3 • 54 y/o female • Subtotal resection of “pituitary macroadenoma” in 2011 • MRIs showed interval growth of mass • Vision symptoms worsening

  10. T1 no Gad T1 post Gad T2 fat sup

  11. Granular Cell Tumor of the Infundibulum • Rare tumor arising in the sellaturcica or in the suprasellar space • Arises from pituicytes, which are specialized astrocytes found in the posterior pituitary (neurohypophysis) • Pituicytes give rise to granular cell tumors and pituicytomas, which are phenotypic variants

  12. Case 4 • 81 y/o female • Presented to OSH with AMS and slurred speech • Developed tonic-clonic seizures • Transferred to UNC for further management

  13. Low-grade astrocytoma

  14. Case 5 • 68 y/o female • CHF, CKD, DM, HTN, • Admitted for CHF exacerbation • 17:00- slurred speech & left sided weakness • 19:00- unresponsive, CT followed

  15. Spontaneous Acute Subdural Hematoma • Spontaneous ASH is a rare but serious condition with a mortality rate of 60—76%. • Frequency of spontaneous ASHs relative to total ASHs is 2—7%. • “Spontaneous” has been used by some authors to indicate ASH due to rupture of a cortical blood vessel unrelated to AVM, berry aneurysm, tumor, metastasis, coagulopathy, hypertension, or cocaine abuse. Other authors simply define “spontaneous SDH” as a hemorrhage occurring in the absence of trauma. • Other potential associations with spontaneous ASH include sudden increase in venous pressure (Valsalva maneuver), anabolic steroid use, and intracranial hypotension. Brennan PM, et al. BMJ Case Reports 2011; doi:10.1136/bcr.01.2011.3694. Fryburg K, et al. Surgical Neurology International2011; 2:44.

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