Multiple Enhancing Intradural, Extramedullary Lesions

A 40-year-old woman presenting with a 1-week history of worsening ascending numbness/tingling, urinary retention, saddle anesthesia, and decreased rectal tone. Sag, sagittal.

A 22-year-old man with a history of a known disorder. Ax, axial; Sag, sagittal.

A 42-year-old woman presenting with recurrent schwannoma proven by pathology and a brain magnetic resonance imaging scan negative for vestibular schwannoma. Sag, sagittal.

A 25-year-old woman with a history of vestibular schwannomas. Sag, sagittal.

A 57-year-old man with a history of von Hippel–Lindau disease. Sag, sagittal.


  • Case A: Abnormal nodular enhancement is noted surrounding the conus and extending along the cauda equina.

  • Case B: Fusiform, mildly enhancing masses involving the cauda equina nerve roots and extending through widened sacral neural foramina into the region of the lumbar plexus. There are additional pelvic and soft tissue lesions. Multiple lesions demonstrate “target signs” with central low signal intensity and peripheral high signal intensity on T2-weighted images.

  • Case C: Two intradural, extramedullary, avidly enhancing nodular lesions are noted inferior to the conus in a patient with a history of an aggressive-appearing recurrent schwannoma located at the level of L5/S1 in the absence of vestibular schwannomas.

  • Case D: Multiple lumbar, intradural, extramedullary, avidly enhancing, rounded lesions are noted along the nerve roots. In addition, cervical images demonstrate enhancing intramedullary lesions (ependymomas) and a partially imaged, dural-based, extraaxial mass superior to the cerebellum (tentorial meningioma).

  • Case E: Multiple intradural, extramedullary enhancing spinal lesions are noted along with multiple prominent serpiginous vessels suggesting highly vascular lesions in a patient with a known history of von Hippel–Lindau (VHL) disease.


Case A

Leptomeningeal carcinomatosis (pathology: diffuse large B-cell lymphoma)

Case B

Neurofibromatosis type 1 (NF1), plexiform neurofibroma

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