gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

The differential diagnosis between intramedullary tumors and non-neoplastic lesions of the spinal cord

Die Differentialdiagnose zwischen intramedullären Tumoren und nicht-neoplastischen Läsionen des Rückenmarks

Meeting Abstract

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  • corresponding author J. Klekamp - Neurochirurgie, Christliches Krankenhaus Quakenbrück

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.02.03

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Klekamp.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Magnetic resonance imaging (MRI) has revolutionized the diagnosis of intramedullary tumors. As these tumors are rare, a significant number of patients present with MRI scans that are considered to show an intramedullary tumor but in fact harbour other neurological diseases. This paper will demonstrate such examples and present radiological and clinical criteria to avoid unnecessary operations on such patients.

Methods: Hospital files, neuroradiological examinations and follow-up examinations were analysed for patients with suspected intramedullary tumors and compared to patients with verified intramedullary tumors.

Results: In a series of 1126 spinal tumors treated between 1977 and 2006, 234 intramedullary tumors (21%) were encountered. During this period, 10 patients presented with MRI scans and suspected intramedullary tumors. Most of these intramedullary lesions showed some enhancement after contrast application. Some but not all lesions were surrounded by perifocal edema. Almost all patients had experienced a rather sudden onset of clinical symptoms with an either fluctuating or rapidly deteriorating clinical course. In contrast, almost all patients with intramedullary tumors presented with a slowly and continuously progressive course and a large intramedullary lesion. Rapid clinical deteriorations for patients with intramedullary tumors were exclusively observed with malignant tumors or after intramedullary tumor hemorrhages. Both can be well distinguished from non-neoplastic lesions with MRI. In all other instances, absence of a space-occupying effect and a rapidly changing clinical pattern indicate a non-neoplastic lesion such as a demyelinating disease. Analysis of cerebrospinal fluid was performed in all doubtful cases but hardly ever disclosed the underlying disease. If in doubt, a repeat MRI after a few weeks can finally rule out the intramedullary tumor in almost all these cases because of significant changes of signal patterns. Such changes of signal patterns in MRI within weeks or months were never observed in intramedullary tumors.

Conclusions: The major distinctive features between intramedullary tumors and a non-neoplastic lesions of the spinal cord are the absence of a space-occupying effect and the rapidly changing clinical course in the latter group. If in doubt, repeat MRI scans after a few weeks can clarify this issue.