A 45 year old female complains of progressive weakness and spasticity of the lower limb with difficulty in micturition. CT scan shows an intradural mid dorsal midline enhancing lesion. The likely diagnosis is:
## **Core Concept**
The question describes a clinical scenario suggestive of a spinal cord lesion given the symptoms of progressive weakness, spasticity of the lower limbs, and difficulty in micturition. The imaging finding of an intradural, mid-dorsal, midline enhancing lesion on a CT scan narrows down the differential diagnoses to conditions that typically present with such characteristics.
## **Why the Correct Answer is Right**
The correct answer, **Ependymoma**, is a type of glioma that arises from the ependymal cells lining the central canal of the spinal cord and the ventricular system of the brain. Ependymomas are known to occur in the spinal cord, particularly in the midline, and can cause symptoms by compressing or infiltrating the spinal cord. They are often intradural and can enhance with contrast on imaging due to their vascularity. The symptoms described, such as progressive weakness, spasticity, and difficulty in micturition, are consistent with a lesion affecting the spinal cord.
## **Why Each Wrong Option is Incorrect**
- **Option A:** Meningioma - While meningiomas can present as enhancing lesions and can be found in the spinal canal, they are more commonly found in the thoracic spine but are usually extramedullary and often attached to the dura.
- **Option B:** Neurocysticercosis - This parasitic infection can cause spinal cord lesions but typically presents with multiple, small, cystic lesions rather than a single, midline, enhancing lesion.
- **Option C:** Astrocytoma - Astrocytomas can occur in the spinal cord and can present with similar symptoms. However, they are less likely to be perfectly midline and are often more infiltrative and less likely to be as distinctly enhancing as ependymomas.
- **Option D:** Hemangioblastoma - These are highly vascular tumors that can occur in the spinal cord, often associated with von Hippel-Lindau disease. They typically present as well-defined, enhancing lesions but are more commonly found in the cervical and thoracic regions and are often associated with a syrinx.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that ependymomas are a common cause of spinal cord tumors, especially in adults, and often present with a long history of slowly progressive symptoms. They are typically located in the midline of the spinal cord, which helps in differentiating them from other spinal cord tumors.
## **Correct Answer:** . Ependymoma