Spinal cord neoplasm can be either a primary central nervous system tumor (glial or nonglial) or secondary to metastases. Clinical features depend on the location of the tumor with regards to the level of the spinal cord, but some of the most common symptoms are localized pain, weakness, isolated sensory or motor dysfunction, as well as inadequate sphincter control. Magnetic resonance imaging (MRI) must be performed in order to make the diagnosis.
Neoplastic diseases of the spinal cord are broadly categorized into two main groups - primary and secondary  . Primary tumors of the spinal cord comprise approximately 2-4% of all central nervous system (CNS) malignancies , and are further divided into intradural intramedullary (where glial tumors, such as ependymomas, hemangioblastomas, and astrocytomas are the main subtypes) and intradural extramedullary (tumors of nonglial origin)   . Conversely, metastatic tumors and lymphomas in the epidural space are the main secondary tumors of the spinal cord  . The clinical presentation somewhat varies on the location of the tumor, but the principal features are progressively worsening localized pain (usually in the neck or back ) that may further spread to the lower extremity (radicular pain)  . The pain is described as constant and is most severe when lying on the side (recumbent position) . In addition, patients frequently report weakness, spasticity, and poor motor control if a nerve root is damaged by the tumor, and both sensory input and sphincter control might also be affected  . Neurological deficits (either sensory, motor or both) caused by a spinal cord neoplasm will frequently present in a bilateral fashion while sparing the head and the face . Some authors describe hydrocephalus as a rare, but significant complication of spinal cord neoplasms, affecting 1-8% of patients   . Unfortunately, the diagnosis of spinal cord neoplasms is frequently delayed (hemangioblastoma is confirmed after a mean period of 3 years), which may profoundly reduce the efficacy of treatment   .
The role of an adequate clinical workup is pivotal in making a presumptive diagnosis of an ongoing process in the spinal cord. Physicians must perform a full physical examination, with an emphasis on the neurological exam with sensory and motor testing, and obtain a complete patient history regarding the course, progression, and duration of symptoms. Imaging studies, however, are vital for recognizing lesions of the spinal cord and determining their exact location   . Magnetic resonance imaging (MRI) is the gold standard, particularly for intramedullary neoplasms, and many studies have emphasized its high rate of success in identifying a spinal cord tumor . Some tumors exhibit specific features on MRI - ependymomas and astrocytomas will be either hypo or isointense on T1-weighed imaged and hyperintense on T2-weighed images, while both tumors are enhanced by the use of contrast . However, MRI might not be always able to differentiate between the exact subtypes of spinal cord neoplasms based on imaging criteria, as certain studies showed a 70% success with histological findings from the tumors . For this reason, a definite diagnosis can only be made after obtaining a sample of the tumor either by performing a biopsy or after surgical resection   . Subsequent histopathological examination and immunohistochemistry testing will be able to provide the answer to the etiology of the tumor .