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Spinal Subdural Metastasis Without Contrast Enhancement on MRI 2004

Rumboldt, Zoran, M.D., Marjan, Domagoj, Sajko, Tomislav, Talan-Hranilovic, Jasna

Excerpta:
A 48-year-old woman was admitted with quadruplegia that developed over 48 hours after a minor trauma. At the time of the trauma (fell on the bathroom floor) the patient felt moderate pain in the neck. Paresthesias and weakness on the right side occured within 24 hours and soon progressed to quadruplegia.

MR imaging showed a well defined intradural extramedullary oval area with signal intensity pattern consistent with hemorrhage anteriorly and to the left of the cord at C4-C5 level. The lesion demonstrated no contrast enhancement and caused severe cord compression and intramedullary areas of hemorrhage and edema.

The patient was immediately taken to surgery and a well defined sub dural hematoma was removed. No extension of the mass to adjacent tissues was seen. There was no clinical improvement postoperatively.

On histology a hemorrhagic metastatic tumor was found. The patient had no known history of primary malignant tumor, and further workup reveled a probable breast cancer. The patient expired after repeated prolonged MRSA pneumonia and pulmonary embolism, and the family refused autopsy.

This case shows that intradural metastatic tumors may not enhance in all cases, especially if the lesion is hemorrhagic.