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Neuroradiology-Neuropathology UNC Monthly Conference

Ray Peeples, MD. Neuroradiology-Neuropathology UNC Monthly Conference. Case 1. 50 y/o F with NF1 hx of meningioma debulking (2/10) and cervical neurofibroma removal (7/09)

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Neuroradiology-Neuropathology UNC Monthly Conference

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  1. Ray Peeples, MD Neuroradiology-Neuropathology UNC Monthly Conference

  2. Case 1 • 50 y/o F with NF1 • hx of meningioma debulking (2/10) and cervical neurofibroma removal (7/09) • MRI studies showed an enhancing superior cerebellar lesion growing over time and eventually causing obstructive hydrocephalus, the lesion was biopsied

  3. 9.10.09

  4. 9.10.09 12.1.09

  5. 10.27.11

  6. 10.2.12

  7. 2.17.13

  8. Pilocytic astrocytoma

  9. In one series of 100 NF1 patients with biopsied tumors, there were… 50 pilocyticastrocytomas (PA) 28 diffuse astrocytomas (Grades II—5%, III—15%, IV—7%) 17 low- grade astrocytomas, subtype indeterminate 2 pilomyxoidastrocytomas 1 desmoplastic infantile ganglioglioma 1 conventional ganglioglioma 24 tumors arose in the optic pathways (14 PAs, 4 low-grade astrocytomas of indeterminate type, 4 anaplastic astrocytomas, 1 pilomyxoid astrocytoma, and 1 ganglioglioma). Most tumors arising in setting of NF1 are pilocyticastrocytomas (PAs) and, unlike their sporadic counterparts, have a distinctive predilection to involve the optic nerve, chiasm, and hypothalamus. NF1-related optic gliomas are typically in young children and afflict 15% to 20% of NF1 patients. NF-1 related optic gliomas seem to have a more indolent behavior than their sporadic counterparts and may even regress without treatment. Gliomas in NF1 Rodriguez FJ, et al. J NeuropatholExpNeurol. 67:240–249, 2008.

  10. Case 2 • 26 y/o M with 2 yrhx of back pain and lower extremity paresthesias • MRI showed and intradural lesion in the L spine • MRI brain showed multiple enhancing cerebellar lesions • Spinal lesion was resected

  11. T2 T1 T2

  12. T1 C+

  13. T2

  14. T1 +C T2 FLAIR

  15. Myxopapillaryependymoma, metastatic

  16. Case 3 • 35 y/o M with 1 year hx of back pain and RLE weakness • sent from outside institutionwith presumptive diagnosis of L3 schwannoma with MRI performed without contrast • EMG showed L3 and S1 radiculopathy • L3 mass was resected

  17. T2 T2 T1 T1 L3 T1 S1 T2

  18. Sarcoidosis

  19. Spinal syndromes are reported at clinical presentation in 6% to 8% of patients with neurosarcoidosis Spinal sarcoidosis can be intramedullary, intraduralextramedullary, epidural, or in vertebral bodies. Most cases are intramedullary. Intradural, extramedullary spinal sarcoidosis is extremely rare, with only 8 cases reported in the literature as of 2006. Spinal sarcoidosis Schaller B, et al. The Spine Journal 6:204–210, 2006.

  20. Case 4 • 26 y/o M who presented in 10/2012 with seizure • CT/MRI showed L frontal low density lesion in white matter with no enhancement, this lesion was biopsied

  21. T1 FLAIR T1 T2 T1 C+ T1 C+

  22. Gliomatosiscerebri

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