Intramedullary Metastases-MRI

An elderly person with known small cell cancer of lung comes with neurological deficits and has demonstrated solitary ,expansile,  intramedullary SOL consistent with intramedullary  metastases . In addition brain metastases are appreciated. Case by Dr MGK Murthy and Mr A.Hamid

Teaching points

4 possible routes are suggested for occurrence

(a)  Arterial haematogenous-supported by the fact that 61% of all intramedullary metastases patients have multiple sites of cerebral and spinal lesions

(b)  Venous route from pelvis by vertebral batson’s venous plexus is suggested

(c)     Leptomeningeal dissemination by CSF

(d)   Direct contiguous spread from the neighboring organs by penetrating the normally protective dura

CEMR is the gold standard with typical lesion described as small, oval, small, with little or no spinal cord defect , with heterogeneous nodular enhancement and pencil thin,  non enhancing , edema more in the cranial aspect.