Daily Radiology Case

Explanation

On MRI of the cervical spine, the lesion appears intramedullary with a well defined cystic component and a vividly enhancing mural nodule on post contrast imaging. The surrounding cord edema explains the patient’s progressive neurologic deficits, with lower motor neuron findings at the level of the lesion and upper motor neuron signs below due to corticospinal tract involvement. The presence of adjacent flow voids suggests a highly vascular tumor, which narrows the differential significantly. Intramedullary tumors such as astrocytomas and ependymomas are considerations, but the classic cyst with enhancing mural nodule configuration, combined with marked vascularity and association with inherited tumor syndromes in young adults, strongly supports this diagnosis.

Source: Gaillard F, Hemangioblastoma - cervical cord. Case study, Radiopaedia.org (Accessed on 18 Feb 2026) https://doi.org/10.53347/rID-19509

Hints

• A 30-year-old male presents with progressive upper extremity weakness and lower extremity spasticity.
• Neurologic exam demonstrates signs of a cervical spinal cord lesion with mixed upper and lower motor neuron findings.
• MRI of the cervical spine reveals an intramedullary mass with surrounding cord edema.
• The lesion contains a well-defined cystic component with an enhancing mural nodule.
• Flow voids are noted adjacent to the lesion, suggesting a highly vascular tumor.
• The patient has a history of retinal vascular lesions and a family history of renal tumors, raising concern for an inherited tumor syndrome.