Increasing Lower Limb Weakness
Case History: 22-year-old female with bilateral lower limb weakness for 25 days.
Case History: 22-year-old female presented with bilateral lower limb weakness for last 25 days. Weakness gradually increased with time.
Weakness gradually increased with time.
Figure 1A, B, C.Whole spine T2WI, T2WI sagittal, and STIR sagittal images. Altered signal intensity (hyperintense on T2WI, STIR, and T1WI) involving vertebral body of L1 vertebra with internal salt pepper appearance. Altered signal intensity (hyperintense on T2WI, STIR and hypo intense on T1WI) lesion is also noted involving bilateral pedicle, transverse process, lamina and spinous process of L1 vertebra and epidural space of spinal canal at that level on left posterolateral aspect suggestive of subacute phase of blood collection causing narrowing central spinal canal and left paracentral and lateral canal with resultant compression over spinal cord and displacing it towards right side and compression over left traversing and exiting nerve roots. Edematous changes are noted in adjacent left para spinal muscles at level of L1 vertebral body.
Figure 1D, E. T1WI Axial and STIR Axial images. Figure 1A, B, C.Whole spine T2WI, T2WI sagittal, and STIR sagittal images. Altered signal intensity (hyperintense on T2WI, STIR, and T1WI) involving vertebral body of L1 vertebra with internal salt pepper appearance. Altered signal intensity (hyperintense on T2WI, STIR and hypo intense on T1WI) lesion is also noted involving bilateral pedicle, transverse process, lamina and spinous process of L1 vertebra and epidural space of spinal canal at that level on left posterolateral aspect suggestive of subacute phase of blood collection causing narrowing central spinal canal and left paracentral and lateral canal with resultant compression over spinal cord and displacing it towards right side and compression over left traversing and exiting nerve roots. Edematous changes are noted in adjacent left para spinal muscles at level of L1 vertebral body.
Figure 2A, B. Axial GRE sequence, Contrast T1WI Axial and Contrast T1WI sagittal: Heterogeneous enhancement involving body and posterior elements of L1 vertebra and epidural component.
Figure 2C. Axial GRE sequence, Contrast T1WI Axial and Contrast T1WI sagittal: Heterogeneous enhancement involving body and posterior elements of L1 vertebra and epidural component.
On MRI lumbosacral study, altered signal intensity (hyper intense on T2WI, STIR, and T1WI) is noted involving vertebral body of L1 vertebra with internal salt pepper appearance suggestive of hemangioma.
Edematous changes are noted in adjacent left para spinal muscles at level of L1 vertebral body.
Involvement of the entire vertebral body and extension into the posterior elements is rare.
Macroscopically, hemangioma manifests as a soft, well-demarcated, dark red mass.
Microscopically, hemangioma have variable histological features. Hemangioma can be divided into four types.
On radiographs, vertebral hemangioma classically have a coarse, vertical, trabecular pattern, with osseous reinforcement (trabecular thickening) classically described as 'jailhouse striations'.
On MRI, the signal intensity of typical vertebral hemangioma is high signal intensity on both T1 and T2 weighted images.
In most cases, the T1-weighted images of spinal cavernous hemangioma reveal homogenous signal intensity similar to that of the spinal cord and muscle, whereas on T2-weighted images, the signal of the lesion is consistently high.
In radiologic evaluation of vertebral hemangioma, Laredo et al described radiographic criteria seen significantly more often in cases of compressive (atypical) vertebral hemangioma than of asymptomatic vertebral hemangioma.
Patient was operated to relieve neurological compression and biopsy was taken which on histopathological examination was proven as vertebral hemangioma.
