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was noted in the left anterolateral spinal cord at the
level of the C1-C2 vertebrae [Figures 2 and 3]. A left
anterior-lateral herniated disk was also noted in the
C5-C6 level which was not present in the initial
MRI at diagnosis [Figures 2 and 4]. Three lumbar
punctures were negative for malignant cells. The
possibility of ependymoma recurrence was therefore
ruled out and the symptoms were attributed to
radiation-induced effect. The patient continued to be
followed with frequent MRI. Although the following-
up MRI demonstrated progressive reduction of the
enhancing abnormality in the upper cervical cord,
the patient’s symptoms persisted and she presented
to our clinic for a second opinion. The neurological
examination was unremarkable except for decreased
pinprick and temperature sensation in her right side
below the C5 dermatome. Additional MRI of the brain
(not shown) and the cervical spine were performed
which revealed disappearance of the previously noted
small abnormality in the left C2 spinal cord area but
persistence of the herniated C5-C6 disk [Figures 5 and 6].
The diagnosis of right-sided numbness due to selective

Figure 2: T1-weigheted MRI with contrast of the C-spine when the patient
developed right-sided numbness. There is no evidence of tumor recurrence
in the posterior fossa but there is an enhancing spinal cord abnormality at the
C2 level (arrowhead), and a herniated disk at the C5-C6 level (arrow). MRI:
magnetic resonance imaging

Figure 1: Pre-surgical T1-weigheted sagittal MRI with contrast of the C-spine.
The large homogenously enhancing tumor of the posterior fossa is seen but no
evidence of leptomeningeal disease or herniated disk at the C5-C6 level. MRI:
magnetic resonance imaging
pressure of the left anterolateral spinothalamic tracts
by the herniated C5-C6 disk was therefore made.
DISCUSSION

Ependymomas in adults are more frequently
supratentorial (approximately 2/3 of cases) in contrast Figure 3: Transverse T1-weigheted MRI section with contrast through the C2
to children that are infratentorial. When they are area revealed the small cord abnormality to be located in the left anterolateral
[1]
region without mass effect, consisted with radiation damage. MRI: magnetic
located in the posterior fossa, they can fill the fourth resonance imaging

66 Neuroimmunol Neuroinfammation | Volume 3 | March 14, 2016