Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
May 2018
Next Case Coming June 5...
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.
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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
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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.
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