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Images in Neurology
November 2009

Intramedullary Spinal Cord Metastasis

Arch Neurol. 2009;66(11):1422. doi:10.1001/archneurol.2009.245

A 48-year-old woman with stage IIIA non–small-cell lung cancer presented with progressive hypoesthesia and weakness in her lower limbs, without pain. On examination, superficial and deep sensibilities were diminished below the T7 level, and she had a mild paraparesis with proximal predominance. Urinary and anal sphincter functions were normal. Magnetic resonance imaging of the dorsal spine showed an increase in diameter of the spinal cord, with hyperintensity on T2-weighted images and gadolinium enhancement from T7 through T8. Magnetic resonance imaging of the brain and cervical spine both appeared normal, while cerebrospinal fluid testing eliminated meningeal involvement. Whole-body fluorine-18-labeled deoxyglucose–positron-emission tomography/computed tomography (18-FDG-PET/CT) showed increased uptake of FDG in the mediastinum ganglia (Figure 1, arrowheads) and in the spinal cord at the T8 level (Figure 1 and Figure 2, arrows), compatible with intramedullary spinal cord metastasis (ISCM).