A 37-year-old female presented with gradually progressive asymmetric ascending paraesthesia and weakness involving bilateral upper and lower limbs. The MRI spine images revealed expansile intramedullary, solid cystic, peripherally enhancing lesion with a haemosiderin cap along the lower margin. The lesion extended into the left C5 and C6 nerve root exit zones, along with thickening and enhancement of the nerve roots. She underwent excision of the lesion, which revealed intramedullary schwannoma on histopathological examination. Presence of the cap, an extension of the lesion into the nerve root exit zone, with associated thickening and enhancement of the dorsal nerve roots should alert the radiologist to consider the possibility of intramedullary schwannoma rather than ependymoma.
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Sekar, S., Vinayagamani, S., Thomas, B. et al. Haemosiderin cap sign in cervical intramedullary schwannoma mimicking ependymoma: how to differentiate?. Neuroradiology 61, 945–948 (2019). https://doi.org/10.1007/s00234-019-02229-6