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Name of the Patient : Abc XyzPanjlmn / M / 27 yrs.
Referred by : Dr. Abc Xyztrak.
Examination : M.R.I. of the Dorsal Spine.

CLINICAL PROFILE :

Known C/O Pulmonary Kochs in 0000. Inadequately treated. Developed weakness in BLE and BUE in June 0000. CT Scan in February 0000 s/o TB arachnoiditis. Treated with AKT and Steroids.
At present upper limb weakness resolved with minimal weakness in the lower extremities.

EXAMINATION :

M.R.I of the dorsal spine was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and T2 Weighted axial images.
The lumbar spine was screened with 5 mm thick T1 Weighted sagittal images.

After administration of contrast following parameters were used :

5 & 4 mm thick T1 Weighted sagittal images through the dorsal and cervical spines, respectively, with fat saturation.
5 mm thick T1 Weighted sagittal images through the lumbar spine.
5 mm thick T1 Weighted axial images through the dorsal region.

OBSERVATION :

There is seen a small, approximately 6.0 mms diameter sized intramedullary lesion within the dorsal spinal cord, posteriorly, at the D5-D6 disc level. This lesion is of intermediate signal on the T1 Weighted images and appears relatively hypointense on the T2 Weighted images.
Scan-00001


The visualized dorsal spinal cord over atleast D4 to D11 vertebral levels shows a hypointense signal, centrally on the T1 Weighted images, which appears hyperintense on the T2 Weighted images. Slight increase in diameter of the dorsal spinal cord over these levels is noted.

Another, subcentimeter, focal lesion following the signal characteristics of the above described intramedullary lesion is noted along the posterior margin of the dorsal spinal cord at the
D7 vertebral level (scans 104.4 & 105.4). This lesion appears to be intradural-extramedullary in location.

After contrast administration, there is rim enhancement of the intramedullary lesion at the D5-D6 level, disc enhancement of the intradural-extramedullary lesion at the D7 vertebral level and enhancement of the posterior meninges in the dorsal region over about D3 to D8 vertebral levels.

The visualized dorsal vertebral bodies and intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.

There is no cord compression.

The conus medullaris terminates at the L1-L2 level.

Screening images of the lumbo-sacral spine do not reveal any significant feature of note.

There is no other focal area of abnormal enhancement in the cervical spinal cord or the meninges on this study.

IMPRESSION :

1. Rim enhancing intramedullary lesion at the D5-D6 disc level and disc enhancing intradural-extramedullary lesion at the D7 vertebral level as described most likely represent tuberculous granulomas in the given clinical setting.
..3/.






- 3 - Scan-00001



Leptomeningeal enhancement along the posterior margin of the dorsal spinal cord over about D3 to D8 vertebral levels as described represent chronic meningitis, in the given clinical setting.

2. Altered signal in the visualized dorsal spinal cord over the D4 to D11 vertebral levels most likely represent gliotic changes, the sequelae of previous arachnoiditis. The possibility of this signal change representing edema due to the intramedullary granuloma seems less likely.



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