spinal cavernous malformations

Location,
length, and enhancement: systematic approach to differentiating intramedullary spinal cord lesions. Cavernoma. A 40-year-old female with left upper extremity numbness. a Sagittal T2 image shows a short segment mixed signal lesion and layering of low signal at the inferior aspect. b The lesion is hypointense on the sagittal GRE image. c Sagittal T1 post-contrast image shows minimal strands of enhancement
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Spinal cord
cavernous malformation • Cervical spinal cord cavernoma - Ganzer Fall bei Radiopaedia
Liaqat K, Cervical spinal cord cavernoma. Case study, Radiopaedia.org (Accessed on 20 Dec 2022) https://doi.org/10.53347/rID-29974 • CC by-nc-sa 3.0 (modified)
Spinal cord
cavernous malformation • Cavernoma of cervical cord - Ganzer Fall bei Radiopaedia
Gaillard F, Cavernoma of cervical cord. Case study, Radiopaedia.org (Accessed on 20 Dec 2022) https://doi.org/10.53347/rID-50838 • CC by-nc-sa 3.0 (modified)
Spinal cord
cavernous malformation • Dorsal cord cavernous malformation - Ganzer Fall bei Radiopaedia
Ibrahim D, Dorsal cord cavernous malformation. Case study, Radiopaedia.org (Accessed on 20 Dec 2022) https://doi.org/10.53347/rID-81284 • CC by-nc-sa 3.0 (modified)
Spinal cord
cavernous malformation • Cervical cord cavernoma - Ganzer Fall bei Radiopaedia
Bickle I, Cervical cord cavernoma. Case study, Radiopaedia.org (Accessed on 20 Dec 2022) https://doi.org/10.53347/rID-87395 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Spinal cord cavernous malformations, also known as spinal cavernomas, are vascular malformations that occur within the spinal cord.

This article specifically relates to spinal cord cavernomas. For a discussion of cerebral cavernomas and a general discussion of the pathology refer to the main article cerebral cavernous malformation.

Epidemiology

Spinal cord cavernomas are rare, representing ~5% of intramedullary lesions in adults and 1% of intramedullary lesions in children .

Peak presentation is during the fourth decade, which is similar to the peak incidence of cerebral cavernomas . Females are more commonly affected than males.

Clinical presentation

Common presenting symptoms include pain, weakness and paresthesias. Four patterns of clinical presentation have been described :

  • discrete episodes of neurological deterioration with varying degrees of recovery between episodes
  • slow progression of neurological decline
  • acute onset of symptoms with rapid decline
  • acute onset of mild symptoms with subsequent gradual decline lasting weeks to months

Episodes of hemorrhage have been proposed as the mechanism underlying acute episodes of neurological deterioration. Progressive myelopathy may be caused by micro hemorrhages and gliosis.

Pathology

Like intracranial cavernomas, spinal cavernomas consist of blood-filled endothelial-lined spaces lined by thickened, hyalinised walls that lack elastic fibers and smooth muscle .

Site

More than half of spinal cavernomas are located in the thoracic cord. The second most common location is the cervical cord .

Radiographic features

CT
  • often occult
Angiography
  • often occult
MRI

Minimal cord expansion or edema unless there has been recent hemorrhage.

  • rounded regions of heterogeneous signal intensity on T1 and T2 weighted images due to blood products of varying ages (“popcorn appearance”)
  • low signal intensity rim on T2 weighted images (hemosiderin)
  • gradient echo (GE): there can be hypointense “blooming” on gradient echo sequences (hemosiderin)
  • T1 C+ (Gd): may demonstrate minimal enhancement on post-contrast images

Treatment and prognosis

Early surgical resection should be considered for all symptomatic patients before repeated hemorrhage or enlargement occur .

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu spinale kavernomatöse Malformationen:
zerebrale
Kavernome
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