Intended for healthcare professionals

Endgames Case Review

An intramedullary mass

BMJ 2021; 374 doi: (Published 01 September 2021) Cite this as: BMJ 2021;374:n1948
  1. Jun-Song Yang, consultant1,
  2. Lei Chu, attending doctor2,
  3. Liang Yan, chief physician1,
  4. Ding-Jun Hao, chief physician,, professor1
  1. 1Department of spinal surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
  2. 2Department of Orthopaedics, the Second Affiliated Hospital Chongqing Medical University, Chongqing, China
  1. Correspondence to D-J Hao dingjun.hao{at}

A man in his 30s presented with one month of progressive bilateral numbness and paralysis in the lower extremities. He had a history of pulmonary tuberculosis two years earlier, which resolved after treatment with isoniazid, rifampicin, and ethambutol. Physical examination showed hypoesthesia below the level of T10; grade I strength in the bilateral iliopsoas, quadriceps femoris, and tibialis anterior muscles; and bilateral lower extremity hyperreflexia. Gadolinium enhanced magnetic resonance imaging (MRI) detected a mass in the thoracic canal (fig 1).

Fig 1

Gadolinium enhanced MRI of the thoracic spine (sagittal plane) showing a “target” sign—a ring enhancing intramedullary lesion with a clear border measuring 0.8 cm×3.0 cm×0.8 cm (red arrows) …

View Full Text

Log in

Log in through your institution


* For online subscription