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Age / Sex : 74 / F
Chief complaint: numbness of both hands (duration: 3 weeks) 1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.) Courtesy: 서경진(Kyung Jin Suh), 동국대경주병원(Donguk University Gyungju Hospital)
Diagnosis: Retro-odontoid pseudotumor
Discussion
Findings:
Relatively well-defined, anterior epidural
mass at C1-2 level
Low signal intensities on T1- and T2-WI
Focal high signal lesion at superior portion
of the mass on T2-WI
Small bone erosion at C2 body
No enhancement
No evidence of atlanto-axial subluxation
Differential Diagnosis:
Rheumatoid arthritis
Spondyloarthropathy
Diagnosis:
Retro-odontoid pseudotumor
Discussion:
A
retro-odontoid pseudotumor (ROP) is a non-neoplastic mass at the
craniovertebral junction; it causes spinal cord compression, which in turn
causes neurological symptoms. In almost all patients with an ROP, it is
associated with atlantoaxial subluxation (AAS). ROP is caused by
mechanical stress exerted by the AAS on the atlas ligaments. From the
pathological viewpoint, an ROP is composed of fibrous granulation or
fibrocartilaginous tissue.
Summary
Clinical
Non-neoplastic mass at the craniovertebral
junction
Occurs in elderly person
Causes spinal cord compression and neurologic
symptom
Mechanical stress due to AAS is considered to
cause ROP
Sometimes associated with rheumatoid arthritis
Excessive mobility increased the mechanical stress
between C1 and C2 can be occurred
Repeated tear and repair of the ligaments (PLL
and transverse ligament) resulting in development of ROP
Pathology:
Composed of fibrous granulation or fibrocartilaginous tissue.
Imaging
findings: MRI
Hypo- or isointense area on T1-WI
An area of low or mixed intensity on T2-WI
No enhanced
References:
1.
Tanaka S,
Nakada M, Hayashi Y, et al. Retro-odontoid pseudotumor without
atlantoaxial subluxation. J of
Clinical Neuroscience 2010;17: 649-652.
2.
Sze G, Brant-Zawadzki
MN, Wilson CR, et al. Pseudotumor
of the craniovertebral junction associated with chronic subluxation: MR imaging
studies. Radiology 1989;161:391–394.
Crockard HA, Sett P, J. Geddes
JF, et al. Damaged ligaments at the
craniocervical junction presenting as an extradural tumor: a differential
diagnosis in the elderly. J
Neurol Neurosurg Psychiatry 1991; 54: 817–821
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