Fig 4.

Atypical intramedullary spinal cord metastasis with central cystic change/necrosis. A 55-year-old man with recent nephrectomy of a renal cell carcinoma presented with 2 weeks of predominantly left upper extremity pain, paresthesias, and weakness, as well as global hyperreflexia. Cervical spine sagittal T2-weighted (A), T1-weighted (B), and postcontrast fat-saturated T1-weighted images (C), and postcontrast axial T1-weighted image are shown. A mass within the cord at the level of C5 has markedly hyperintense central signal on T2-weighted imaging (A) and corresponding T1 hypointensity (B) consistent with central cystic change/necrosis. The sagittal (C) and axial (D) T1-weighted postcontrast images demonstrate the peripheral enhancement with lack of central enhancement corresponding to the region of central cystic/necrotic change. This represents 1 of only 2 cases in the current series of intramedullary spinal cord metastasis demonstrating cystic/necrotic change. The primary tumor type in the other case (not shown) was lung carcinoma.