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Findings

Expansile mass involving the conus

T2 hyperintense component with septation

Solid nodular component that is predominantly isointense on T1 and enhances with gadolinium

Focus of T1 pre-contrast hyperintensity that is compatible with hemorrhage

Hyperintense on STIR

Differential Diagnosis

Myxopapillary ependymoma

Nerve sheath tumor

Intradural metastases

Acquired epidermoid

Meningioma

Paraganglioma

Myxopapillary Ependymoma

T1 hyperintense, enhancing, hemorrhagic mass associated with the filum terminale is highly suggestive.

Slow growing glioma arising from the ependymal cells of the filum terminale.

Presentation

Back pain

Paraparesis, radiculopathy, incontinence

Symtoms may mimic disc herniation, resulting in delay in diagnosis

Peak age 20-30, M:F – 2:1

Treatment

Surgical resection

Excellent prognosis with complete resection

Risk of local recurrence with incomplete resection

Radiotherapy in recurrence or subtotal resection

Adjuvant therapy for multifocal lesions

Ross JS: Diagnostic Imaging-Spine. Salt Lake City, 2004, Amirsys Inc.