Total intravenous anesthesia with propofol in pediatric patients for MR examination.

The failure of MR to clearly detect the second lesion was significant for two reasons. Had this drop metastasis not been discovered, adjuvant radiation therapy may not have been given; and because the lesion was not seen on MR, it is unclear what imaging strategy should be used to follow the patient. We agree with Epstein et al ( 1) that in a patient with a neurologic deficit and a negative or equivocal MR, a myelogram may be of value. Further, this case demonstrates that the drop metastases of myxopapillary ependymoma can have an MR appearance similar to cerebrospinal fluid, making them difficult to resolve.