Radiation-induced myelitis of the medulla oblongata and the cervical cord with bone marrow signal changes
Presentation
Left sided weakness and hemiparesis. History of nasopharyngeal carcinoma post-radiotherapy.
Patient Data
Subtle hypodensity of the medulla oblongata. The rest of the study is unremarkable.
The medulla oblongata as well as the cervicomedullary junction, cervical and scanned upper thoracic cord is grossly enlarged with diffusely hyperintense T2 and FLAIR signal intensity as well as mildly hypointense T1 signal with some restricted diffusion and mild heterogeneous post-contrast enhancement.
The clivus and the skull base as well as the scanned cervical and upper thoracic bony spine show fatty infiltration with hyperintense T1 and T2 signal intensity.
No nasopharyngeal mass lesions.
Normal size and configuration of the ventricular system.
No supratentorial mass lesions or definite parenchymal areas of abnormal signal intensity.
Normal cortical sulci with no extra-axial collection.
Normal cerebellum.
Bilateral otomastoiditis with T2 prolongation as well as mild ethmoidal and sphneoidal sinusitis.
Case Discussion
Post irradiation demyelination and myelitis of the medulla oblongata, cervicomedullary junction as well as the cervical and scanned upper thoracic cord with post-irradiation fatty marrow changes of the clivus, skull base and the cervicothoracic spine.
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