Case 4

This is an MRI lumbar spine study, showing a low lying conus medullaris at S1 level – indicating a tethered cord. The filum terminale is thickened, and is attached to an intradural, linear lesion at S1/S2 level, which shows very high signal intensity on both T1 and T2 images – this represents a lipoma of the filum terminale which the cord is attached to. There is also expansion of the thecal sac, indicating dural ectasia which results from abnormalities of CSF flow and increased intrathecal pressure.

The diagnosis is tethered cord syndrome caused by an intradural lipoma.

I also note that the L4/5 intervertebral disc shows loss of the normal high T2 signal and marked loss of height, indicating degeneration, along with posterior bulge and bilateral intervertebral foraminal stenosis.

I would review any plain films or CT studies if available to better assess the bony elements; I would also recommend neurosurgical referral / discussion at neurosurgery MDT.