T2 Hypointense Schwannoma Masquerading As A Vascular Lesion: A Case Report

Neurohospitalist. 2022 Oct;12(4):659-663. doi: 10.1177/19418744221112539. Epub 2022 Jul 1.

Abstract

Spinal schwannomas are rare nerve root tumors that typically produce subtle symptoms from nerve root compression. These tumors are known to be heterogeneously hyperintense on T2-weighted MRI and avidly enhance with contrast. However, here we describe an L5 spinal schwannoma in a 66-year-old woman that was hypointense on T2-weighted imaging with other radiographic findings more closely aligning with a vascular lesion. The neuroradiologic characteristics on MRI, time resolved MR angiography, and catheter digital subtraction angiography are presented. The patient underwent a full workup for possible dural arteriovenous fistula and thrombosed venous varix before the nerve sheath tumor was discovered intraoperatively and confirmed as a schwannoma on histopathology.

Keywords: nerve compression syndromes; neurooncology; spinal cord diseases.