Neurorad-Neuropath Conference
April 2013
Stephen Bagg, MD
Neuroradiology Fellow, UNC
Case 1
41 y/o male
18 months of progressive back pain radiating down right leg
No significant past medical history
Tanycytic ependymoma
• Ependymal tumors include the following:
-Subependymoma, WHO grade I
-Myxopapillary ependymoma, WHO grade I
-Ependymomas (cellular, papillary, clear cell, tanycytic variants), WHO II
grade II
-Anaplastic ependymoma, WHO grade III
• Tanycytes are interspersed among the more common columnar-shaped ependymal
cells in the floor of the third ventricle, some of the circumventricular organs such as
the hypophysis, pineal gland, subcommisural organ, area postrema and organum
vasculosum of the lamina terminalis. Tanycytes are distinguished by a long
nonbranching cytoplasmic process that extends into the neuropil to the surface of
blood vessels and neurons. (“Tanycyte” is derived from the Greek word meaning to
“stretch”.)
• 65% of tanycytic ependymomas are in spinal cord, but rarely cauda equina. They are
circumscribed and usually have a good prognosis.
Tosun O, et al. Spinal tanycytic ependymoma with diffusion restriction on MRI. Acta Neurologica Belgica. 112:77-80, 2012.
Radhakrishnan N, et al. Tanycytic ependymoma of filum terminale: A case report. Clinical Neurology and Neurosurgery 114 (2012) 169– 171.
Case 2
61 y/o female
Left lower extremity pain
Remaining history noncontributory
T2
T2 STIR
T1 no Gad
T1 post Gad
T2
T1 no Gad
T1 Post Gd
Hemangioblastoma
Primary intramedullary tumors of the spinal cord
Karikari I, et al. Impact of Tumor Histology on Resectability and Neurological Outcome in Primary Intramedullary Spinal Cord Tumors:
A Single-Center Experience With 102 Patients. Neurosurgery 68:188–197, 2011
Case 3
54 y/o female
Subtotal resection of “pituitary macroadenoma” in 2011
MRIs showed interval growth of mass
Vision symptoms worsening
T1 no Gad
T1 post Gad
T2 fat sup
Granular Cell Tumor of the Infundibulum
• Rare tumor arising in the sella turcica or in the
suprasellar space
• Arises from pituicytes, which are specialized
astrocytes found in the posterior pituitary
(neurohypophysis)
• Pituicytes give rise to granular cell tumors and
pituicytomas, which are phenotypic variants
Case 4
81 y/o female
Presented to OSH with AMS and slurred speech
Developed tonic-clonic seizures
Transferred to UNC for further management
Low-grade astrocytoma
Case 5
68 y/o female
CHF, CKD, DM, HTN,
Admitted for CHF exacerbation
17:00- slurred speech & left sided weakness
19:00- unresponsive, CT followed
Spontaneous Acute Subdural Hematoma
• Spontaneous ASH is a rare but serious condition with a mortality rate of
60—76%.
• Frequency of spontaneous ASHs relative to total ASHs is 2—7%.
• “Spontaneous” has been used by some authors to indicate ASH due to
rupture of a cortical blood vessel unrelated to AVM, berry aneurysm, tumor,
metastasis, coagulopathy, hypertension, or cocaine abuse. Other authors
simply define “spontaneous SDH” as a hemorrhage occurring in the absence
of trauma.
• Other potential associations with spontaneous ASH include sudden increase
in venous pressure (Valsalva maneuver), anabolic steroid use, and
intracranial hypotension.
Brennan PM, et al. BMJ Case Reports 2011; doi:10.1136/bcr.01.2011.3694.
Fryburg K, et al. Surgical Neurology International2011; 2:44.