May 2018
A 62-year-old man with pain in the left rib cage and left leg, paresis of the lower left limb, impaired urination and constipation, and delayed ejaculation. Physical examination revealed hypertonia and hyperreflexia of the lower limbs.
Idiopathic Spinal Cord Herniation
- Background:
- Idiopathic spinal cord herniation, unlike spinal cord herniation with a known traumatic or postoperative origin, is a relatively rare condition.
- It results from a dural defect of unknown origin.
- Clinical Presentations:
- Patient age ranges from 20–80 years.
- Slightly more common among women
- Brown-Séquard syndrome is frequently described as a presenting feature.
- Other major symptoms may include numbness and decreased temperature sensation in the legs, gait disturbances, pain, and incontinence.
-
Key Diagnostic Features:
- Idiopathic herniations most commonly occur between the T2 and T8 vertebrae.
- On sagittal MR images, the anterior spinal cord is kinked and distorted toward the anterior dural.
- Occasionally, the herniated spinal cord can be seen in the extradural space. Cord atrophy and T2 hyperintensity can also be seen.
- Ways to distinguish this entity from an arachnoid cyst include phase-contrast cine MR imaging to show CSF flow in the subarachnoid space posterior to the herniated spinal cord and high-resolution steady-state T2WI.
- Differential Diagnosis:
- Intradural arachnoid cyst
- Extradural mass with cord compression
-
Treatment:
- Surgical reduction of the herniated spinal cord (with intraoperative neurophysiologic monitoring) may result in an improvement of symptoms even in patients with chronic neurologic dysfunction.
