LESIONS

A Guide to Localisation in Neurology

Case 4. Progressive lower limb numbness

Outcome

An MRI identified a lesion at T8/9 growing from the meningeal space (Image A, sagittal T2 MRI). This had homogenous contrast enhancement (B, T1 MRI with contrast). There was evidence of lateral displacement of the spinal cord (C, axial MRI).

Imaging was consistent with a meningioma. Reassuringly there was no evidence of metastatic disease on body imaging.

She subsequently underwent surgical resection of the lesion, with an uncomplicated peri-operative course.

At follow-up she reported improvement in some of the features though some residual sensory changes in the legs. These were manageable however, and not disabling - and importantly, the operation had prevented further progression (for example causing walking difficulty).

Thoracic spinal meningioma causing cord compression and bilateral loss of dorsal column sensory modalities

1. Sensory disturbance in the feet and lower legs could indicate neuropathy, cauda equina or spinal cord disease
2. Neuropathy affecting the thighs will involve the hands - whereas numbness affecting the entire leg without hand involvement suggests a cauda equina or spinal disorder
3. A sensory level is a sign of a cord disorder - the lesion is usually 1-2 segments higher than the level