Radiological Category Neuroradiology Principal Modality 1 MRI Principal

Case History 25 -year-old female with neck and lower back pain.

Test Your Diagnosis Which one of the following is your choice for the appropriate

Findings and Differentials Findings: -No acute abnormalities of the cervical spine. -Multiple vertebral segmentation

Discussion • Diastatomyelia: sagittal division of the spinal cord into 2 hemicords by a

Discussion • Lipomyelomeningocele: subcutaneous fatty mass contiguous with neural placode/lipoma through posterior dysraphism. –T

Diagnosis Diastatomyelia with tethered cord and filum terminale lipoma.

References Weissleder et al. Primer of Diagnostic Imaging. 4 th ed. Philadelphia, PA: Mosby

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Radiological Category: Neuroradiology Principal Modality (1): MRI Principal Modality (2): General radiography Case Report # 789 Submitted by: Ravinder Legha, M. D. Faculty reviewer: Scott Serlin, M. D, The University of Texas Medical School at Houston. Date accepted: 15 March, 2011

Case History 25 -year-old female with neck and lower back pain.

Radiological Presentations

Test Your Diagnosis Which one of the following is your choice for the appropriate diagnosis? After your selection, go to next page. • Lipomyelomeningocele • Hydrosyringomyelia • Diastatomyelia • Diplomyelia

Findings and Differentials Findings: -No acute abnormalities of the cervical spine. -Multiple vertebral segmentation anomalies with fusion of T 12 and L 1. Hypoplastic L 1 L 2 disc space with an L 2 hemivertebra. L 3 -4 fusion with no intervening disc. -Small posterior split of the spinal cord at T 11 progressing to two separate cords at L 1 within one dural sac with a bony/ligamentous septum at L 2 -3. The cords then fuse to form a normal-appearing conus at L 4, which is tethered with a filum terminale lipoma. -Narrowing of the left neural foramen at L 5 -S 1 related to facet hypertrophy. Differentials: • Diastatomyelia with low lying/tethered cord • Diplomyelia • Lipomyelomeningocele • Hydrosyringomyelia

Discussion • Diastatomyelia: sagittal division of the spinal cord into 2 hemicords by a fibrous septum or bony spur, usually thoracolumbar (85% below T 9). Hemicords usually reunite above and below cords. Commonly associated with tethered cord, hydromyelia, abnormal vertebral bodies, meningocele, myelomeningocele, and lipomyelomeningocele/ –-T 1 WI: 2 hemicords +/- syringomyelia (50%). +/- isointense (fibrous) or hypointense (osseous) spur. –-T 2 WI: 2 hemicords +/-syringomyelia (50%) in one or both cords, surrounded by bright CSF. • Diplomyelia: two complete spinal cords, each with two anterior and posterior horns and roots.

Discussion • Lipomyelomeningocele: subcutaneous fatty mass contiguous with neural placode/lipoma through posterior dysraphism. –T 1 WI: hyperintense lipoma contiguous with subcutaneous fat, tethered cord/placode. Herniation of placode-lipoma complex immediately inferior to last intact lamina above dorsal defect. –T 2 WI: hyperintense lipoma, neural elements isointense on background of hyperintense CSF. • Syringomyelia: expanded, cystic spinal cord cavity not contiguous with central cord canal. –-T 1 WI: hypointense spinal cord cleft best demonstrated on sagittal images. –-T 2 WI: hyperintense intramedullary cavity +/- adjacent gliosis, myelomalalica –-T 1 WI C+: nonenhancing cavity. Enhancement suggests inflammatory or neoplastic lesion.

Diagnosis Diastatomyelia with tethered cord and filum terminale lipoma.

References Weissleder et al. Primer of Diagnostic Imaging. 4 th ed. Philadelphia, PA: Mosby Elsevier, 2010. Youssem et al. Neuroradiology: The Requisites, 3 rd ed. Philadelphia, PA: Mosby Elsevier, 2010. www. statdx. com