A 15 Year Old Female with Progressive Quadriparesis
- this girl I hope we can find the proper help for her
- I don't think spinal instrumentation is necessarily after total removal of osteoma.
Case Explanation: Explanation of Answers
This lesion has imaging characteristics of osteochondroma. These benign lesions appear as calcified masses on CT, often attached to a bony surface via a bony pedicle. There is typically no bony destruction unless malignant transformation has occurred (a rare finding). MRI can show post-contrast enhancement that usually spares the cartilaginous cap of the mass. Lesions typically do not increase in size after skeletal maturity occurs. Growth after skeletal maturity, especially when accompanied by pain and bony destruction on imaging should prompt concern for malignant transformation. Imaging of the remainder of the neuraxis is indicated in this age group. Complete surgical resection without radiation is generally curative. The left PICA infarct presented is, in this case, likely from malpositioned cervical instrumentation in the lateral mass. CT angiogram will demonstrate the vertebral artery injury that caused the likely PICA infarct. MRI of the brain should confirm the infarct.
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