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Wagener Granulomatosis of the Cervical Spine 2008

General Spine

Alexander Lerner, MD,
Soma Sahai, MD, Non ASSR Member
Deborah L Commins, MD, Non ASSR Member
John L Go, MD, ASSR Member

Excerpta Extraordinaire

Excerpta

Wagener Granulomatosis of the Cervical Spine.

Purpose

To describe an unusual case of Wegener Granulomatosis involving the cervical spine.

Methods & Materials

A 32 year old Hispanic female with no known primary neoplasm presented to our institution with a 3 year history of a dural based mass involving the left cavernous sinus, parasellar region, and tentorium. Brain biopsy of the mass at that time suggested a granulomatous, inflammatory mass. AFB cultures and ACE levels were negative for tuberculosis and sarcoidosis. The patient was treated with steroids and immunosuppressive medication (Imuran) with a mixed response. The patient now presented to the ER with occipital headache and extreme pain upon movement of the neck. MRI of cervical spine with and without IV contrast was obtained.

Results

MRI revealed an anterior extramedullary lesion extending from C1 to C6.
The lesion demonstrated isointense signal on T1-weighted images, isointense to hypointense signal on T2-weighted images, and avid homogeneous enhancement. There was no evidence of vertebral involvement. Due to the compression upon the thecal sac, an emergency decompression was performed. Final diagnosis was Wegener granulomatosis.

Conclusion

Wegener granulomatosis is a rare entity within the spine with a few isolated case reports in the literature. This paper will demonstrate the radiological manifestations of this entity in the spine with a demonstration of the pathology seen and a differential diagnosis for dural based lesions of the spine.

References

Mentzel, Hans-J., Neumann, Thomas, Fitzek, Clemens, Sauner, Dieter, Reichenbach, Jurgen R., Kaiser, Werner A.
MR Imaging in Wegener Granulomatosis of the Spinal Cord
AJNR Am J Neuroradiol 2003 24: 18-21

Provenzale JM, Allen NB. Wegener granulomatosis: CT and MR findings. AJNR Am J Neuroradiol 1996; 17:785-792

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