Prasad A, Brar R, Sinha S, Rana S
Correspondence: Dr Abhishek Prasad, drabhishekprasad@gmail.com
ABSTRACT
Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive myelopathy. This condition has recently seen an increased frequency of diagnosis, possibly due to increased awareness and the use of magnetic resonance (MR) imaging. ISCH is characterised by herniation of the thoracic spinal cord through an anterior or anterolateral dural defect. Patients usually present with a Brown-Séquard-like syndrome, which is gradually progressive and may evolve into severe paraparesis. This disease has a characteristic radiological appearance, and in most cases, excellent postsurgical outcome. We report ISCH and its imaging appearance in a 31-year-old woman with classical presentation, and discuss the current concepts regarding the aetiopathogenesis, radiological features and management of the disease.
Keywords: dorsal spine, idiopathic spinal cord herniation, MRI
Singapore Med J 2013; 54(2): e44–e46; http://dx.doi.org/10.11622/smedj.2013039
REFERENCES
1. Groen RJ, Middel B, Meilof JF, et al. Operative treatment of anterior thoracic Spinal cord herniation: three new cases and an individual patient data meta-analysis of 126 case reports. Neurosurgery 2009; 64(Suppl):145-60. http://dx.doi.org/10.1227/01.NEU.0000327686.99072.E7 | ||||
2. Dix JE, Griffitt W, Yates C, Johnson B. Spontaneous thoracic spinal cord herniation through an anterior dural defect. AJNR Am J Neuroradiol 1998; 19:1345-8. | ||||
3. Parmar H, Park P, Brahma B, Gandhi D. Imaging of idiopathic spinal cord herniation. Radiographics 2008; 28:511-8. http://dx.doi.org/10.1148/rg.282075030 | ||||
4. Blasel S, Hattingen E, Baas H, Zanella F, Weidauer S. Spontaneous Spinal Cord Herniation: MR Imaging and Clinical Features in Six Cases. Clin Neuroradiol 2008; 18:224-30. http://dx.doi.org/10.1007/s00062-008-8028-2 | ||||
5. Najjar MW, Baeesa SS, Lingawi SS. Idiopathic spinal cord herniation: A new theory of pathogenesis. Surg Neurol 2004; 62:161-71. http://dx.doi.org/10.1016/j.surneu.2003.10.030 | ||||
6. Darbar A, Krishnamurthy S, Holsapple JW, Hodge CJ Jr. Ventral thoracic spinal cord herniation: Frequently misdiagnosed entity. Spine (Phila Pa 1976) 2006; 31:E600-5. | ||||
7. Brugieres P, Malapert D, Adle-Biassette H, et al. Idiopathic spinal cord herniation: value of MR phase-contrast imaging. AJNR Am J Neuroradiol 1999; 20:935-9. | ||||
8. Spissu A, Peltz MT, Matta G, Cannas A. Traumatic transdural spinal cord herniation and the nuclear trail sign: case report. Neurol Sci 2004; 25:151-3. http://dx.doi.org/10.1007/s10072-004-0251-2 | ||||
9. Imagama S, Matsuyama Y, Sakai Y, et al. Image classification of idiopathic spinal cord herniation based on symptom severity and surgical outcome: a multicenter study. J Neurosurg Spine 2009; 11:310-9. http://dx.doi.org/10.3171/2009.4.SPINE08691 | ||||
10. Ishida M, Maeda M, Kasai Y, Uchida A, Takeda K. Idiopathic spinal cord herniation through the inner layer of duplicated anterior dura: evaluation with high-resolution 3D MRI. J Clin Neurosci 2008; 15:933-7. http://dx.doi.org/10.1016/j.jocn.2006.10.024 | ||||
11. Hausmann ON, Moseley IF. Idiopathic dural herniation of the thoracic spinal cord. Neuroradiology 1996; 38:503-10 http://dx.doi.org/10.1007/BF00626082 |