Sagittal T2-weighted MRI shows a high signal intensity lesion on T6-T7 levels and a longitudinally extensive tumefactive hyperintense lesion from T6 to the medullary cone
(a) with enhancing on postcontrast series (b).
Magnetic resonance imaging ( MRI) of thoracolumbar spine with gadolinium (Figures 1A, 1B) showed an expansive lesion, with affectation of the distal medullary cone, isointense to spinal cord on T1, heterogeneous intensity, and areas of hyperintensity on T2.
Surgical exploration was conducted of the medullary cone, finding a thickened and hardened epiconus, with arachnoid and healthy skin, a tough avascular intra-axial fibrous lesion, from which samples were taken.
The medullary cone
biconvex mass is iso-intense to subcutaneous fat on all sequences.
The lower cervical segments are the most affected, but cranial extension to the brainstem (syringobulbia) or extension to the medullary cone
might be observed.
T2*-weighted and T2-weighted magnetic resonance imaging (MRI) showed intramedullary bleeding in the central portion of the medullary cone (Figures 1 and 2).
The reason for the patient's complaints was postpuncture intramedullary bleeding in the medullary cone. MRI, especially T2*-weighted GRE imaging, can be very useful in detecting the smallest amounts of intramedullary bleeding (2) because of the paramagnetic effect of iron that is contained in hemoglobin (Figure 1).