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 medullary segments evaluated were the cervical (CS), thoracic (TS), lumbar (LS), and sacrocaudal (SCS) segments and the medullary cone (CM).
The funneling of the lumbar segment of the spinal cord originates in the medullary cone (ERHART, 1992; GETTY et al.
The apex of the medullary cone occurs between the fifth or sixth lumbar vertebra in pigs, between the sixth or seventh lumbar vertebra in dogs, the second sacral vertebra in horses, and more variably between the sixth lumbar and third sacral vertebrae in cats (DYCE et al.
The reported lengths of the medullary cone are 100 mm in horses, 45.
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).
T2*-weighted gradient-recalled echo (GRE) imaging shows the smallest amounts of intramedullary hematoma (Figure 1) in the medullary cone.
Intramedullary bleeding after inadvertent puncture of the medullary cone
The reason for the patient's complaints was postpuncture intramedullary bleeding in the medullary cone.
