• Clinical features of intramedullary ependymomas are variable
• Classic central cord syndrome is infrequent
• Early symptoms are usually non-specific and may subtly progress
• Symptom duration prior to diagnosis is often 3-4 years, although intratumoral hemorrhage may lead to rapid decline
Sensory Symptoms
• Sensory symptoms are the earliest to present in up to 70% of patients
• Dysesthesias are particularly common
• Painful aching sensations localized to the tumor site are rarely radicular
• Distribution and progression of symptoms depend on tumor location
• Upper extremity symptoms predominate with cervical tumors
• Thoracic cord tumors produce spasticity and sensory disturbances in the lower extremities
Numbness and Weakness
• Numbness is a common complaint and typically begins distally in the legs with proximal progression
• Tumors of the lumbar enlargement often present with back and leg pain, which may be radicular
• Urogenital and anorectal dysfunction tend to occur early
• Weakness usually occurs late in disease progression, is usually asymmetric and indicates significant thinning of the surrounding spinal cord
Imaging
• MRI with gadolinium contrast is the imaging modality of choice
• Ependymomas are homogeneously enhancing lesions
• May be associated with syringomyelia or cysts
• Discreteness of the lesion is a characteristic feature
Conclusion
• Intramedullary ependymomas have variable clinical presentations
• Sensory symptoms are the most common early complaint
• Weakness usually indicates significant thinning of the surrounding spinal cord
• MRI with gadolinium contrast is the imaging modality of choice for diagnosis