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.