A 45-year-old man presents with progressive right leg weakness over 3 months. MRI shows a 3 cm intradural extramedullary mass at the T5 level. The mass is isointense on T1, enhances uniformly with gadolinium, and has a 'dural tail' sign. The most likely diagnosis is:
- A Meningioma — correct location and imaging characteristics ✓
- B Schwannoma — most common intradural extramedullary tumor
- C Ependymoma — most common intramedullary tumor in adults
- D Neurofibroma — associated with NF1
Explanation
Spinal meningiomas are the most common intradural extramedullary tumors in women (70-80% are female), occur predominantly in the thoracic spine (80%), and appear as uniform gadolinium-enhancing masses with a broad dural base and the 'dural tail' sign (enhancement extending into adjacent dura). They are WHO grade 1 in most cases and surgical excision is curative. Schwannomas are also common intradural extramedullary tumors, tend to exit the neural foramen ('dumbbell' shape), and are hypointense on T1 with variable enhancement. Ependymomas are intramedullary (within the cord). Neurofibromas are associated with NF1 and also tend to be dumbbell-shaped.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.