Fig. 2.

High-grade astrocytoma. A 59-year-old female who originally presented with gait instability and balance issues. (A) Initial MRI of her thoracic spine demonstrated an expansile intramedullary mass extending from T7 to T10 on T2 sagittal imaging. (B) Sagittal imaging demonstrating no contrast enhancement at original presentation. The patient was clinically observed for over a year until follow-up imaging demonstrated (C) new areas of contrast enhancement (arrow). The patient underwent multilevel laminectomies, duraplasty, and selective biopsy of the contrast enhancing lesion. (D) Postoperative T1-weighted contrast-enhanced imaging demonstrating postoperative changes and biopsy of the lesion. Final pathology demonstrated astrocytoma with high-grade features, negative for IDH1 mutation.