Today we are reviewing the histopathology and clinical courses of two patients who have identical pathologic diagnosis, but different outcomes. The first is a 10-yearold girl who presented at 5 years of age with constipation and mild left hemiparesis. She was the product of a normal gestation and uncomplicated delivery, and was one of identical twins. Growth and development were normal, although she was identified as the ''clumsier'' of the two twins. Radiographs of the spine, legs, and pelvis were done when she was 3 years old due to a fall, and were normal. Symptoms of constipation and external rotation of the left leg began at age 4 years and prompted a neurologic examination at our hospital that was reported as ''normal.'' The frequency of her falls increased, and the summer prior to being seen this time she developed left leg weakness.
Magnetic resonance imaging (MRI) of the spine performed in September 1992 revealed a large intramedullary mass of the cord that extended from C5 through T6. MRIs of the brain and sacral spine were normal. She underwent partial resection of the tumor followed by spinal fusion. The pathologic diagnosis was of a welldifferentiated ganglioglioma. Postoperatively, her neurologic examination was remarkable for contractures of the left ankle, mild left hemiparesis, and left hyperreflexia. No therapy was recommended. After a prolonged convalescence, she went home and has continued to improve clinically.
Dr. Heller, would you please review the imaging findings in the first of the two patients.