What’s the Diagnosis – Case 114
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Findings The conus medullaris (conus) terminates at the inferior margin of the L3 body and there is poor delineation of the conus to the filum terminale (filum). At S1, the filum terminale is prominent measuring slightly greater than 2 mm in width and is associated with focal fatty infiltration. Fatty infiltration is high signal on T1 and yields a chemical shift artifact on the T2 weighted pulse sequences at the interface of fat and fluid of the CSF.
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Diagnosis: Tethered cord/tight filum syndrome The conus medullaris terminates above the L2-L3 disc level in greater than 98% of people and a conus terminating below this is considered low lying. A low lying conus relates to a failure of normal superior migration of the filum terminale. This subsequently yields a thickened filum defined as greater than 2mm at its midpoint or greater than 1mm at the L5-S1 level. Frequently as in this case the low lying cord is associated with fatty infiltration which can either be a tubular, fatty fibrolipoma or a focal mass or so called terminal lipoma. A tethered cord can either be discovered in children or in adults but the symptoms associated with this finding are frequently different. Many adults present with pain frequently following activity and leg weakeness which are not typical in children. Both adults and children may have urologic symptoms or paresthesias
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References Adult tethered cord syndrome mimicking lumbar disc disease. Ahmet Sukru Umur, Mehmet SelcukiDeniz Selcuki, Altay Bedük, Latife Doganay.Child's Nervous System. July 2008, Volume 24, Issue 7, pp 841–844 Tight Filum Syndrome. Larry B. Poe, M.D. Radsource. MRI Web Clinic Jul 2009
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