Intracranial hypotension as a cause of radiculopathy from cervical epidural venous engorgement: case report.
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We describe the case of a 40-year-old man with spontaneous intracranial hypotension who presented with cervical radiculopathy associated with epidural venous engorgement. Epidural venous engorgement can occur secondary to intracranial hypotension and manifests intracranially as pachymeningeal venous engorgement. In the cervical spine, two cases of epidural venous engorgement due to intracranial hypotension have been reported in the literature, and neither patient presented with symptoms related to nerve compression. Epidural venous engorgement should be considered in the differential diagnosis of an enhancing epidural mass in the cervical spine. Diagnostic clues include sparing of the anterior midline and posterior aspects of the epidural space and, if present, pulsation artifact. (+info)
Symptomatic enlarged cervical anterior epidural venous plexus in a patient with Marfan syndrome.
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A 38-year-old man with Marfan syndrome presented with headache and neck pain. MR imaging revealed a large enhancing mass in the cervical anterior epidural space. Cervical laminectomy with biopsy of the lesion revealed a large engorged anterior epidural venous plexus (AEVP). Marfan syndrome may predispose the patient to enlargement of AEVP secondary to a vessel wall abnormality. (+info)
Cauda equina syndrome caused by idiopathic sacral epidural lipomatosis.
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The patient, who was a non-obese woman with no predisposing conditions of lipomatosis, slowly developed cauda equina syndrome. Spinal magnetic resonance imaging (MRI) presented mass lesion of high intensity on T1-weighted image (WI) and an intermediate signal intensity in T2 WI in the epidural space of S1 to coccyges. It has been reported that most idiopathic epidural lipomatosis (IEDL) is observed in obese men, and all cases have involved the thoracic or lumbar region. This is the first report of a patient with cauda equina syndrome caused by idiopathic sacral epidural lipomatosis (EDL). (+info)
Age related shift in the primary sites of involvement in cervical spondylotic myelopathy from lower to upper levels.
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Ascending axonal volleys were analysed after epidural stimulation at multiple sites along the cervical cord to localise the site of the lesion precisely in cervical spondylotic myelopathy. The intraoperative recordings uncovered a single site of focal conduction block in 129 of 136 affected patients who underwent surgical intervention because of evidence of multilevel compression obtained by magnetic resonance imaging. Statistical analyses showed a shift of abnormalities from lower to upper cervical levels with advancing age (p < 0.0001). In particular, 92% of the oldest group (aged over 70 years) had localised dysfunction at C3-4 or C4-5, while 68% of patients aged under 60 years had lesions at C5-6 or C6-7. (+info)
Cervical myelopathy due to a "tight dural canal in flexion" with a posterior epidural cavity.
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A 41-year-old man noticed weakness and atrophy in his right hand and forearm resembling the non-progressive juvenile muscular atrophy of unilateral upper extremity (Hirayama's disease). MRI showed an abnormal cavity in the posterior epidural space which appeared on neck flexion communicating with the subarachnoid space in addition to the flattening of the lower cervical spinal cord on neck flexion. When evaluating atypical cases of Hirayama's disease, the pathomechanism demonstrated in the present case should be taken into consideration. (+info)
Primary spinal extradural hydatid cyst in a child: case report and review of the literature.
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Spinal hydatid cyst is a rare but serious condition. An 8-year-old boy presented with back pain, progressive weakness and numbness in both legs. Magnetic resonance imaging (MRI) of the lumbar region showed a cystic lesion with regular contour located in extradural space. There was cerebrospinal fluid- (CSF-) like signal intensity on T1- and T2-weighted images. The lesion had excessively compressed the dural sac and caudal roots, and expanded to the L3 and L4 neural foramina. The case was explored with L2, L3, L4 laminectomy and the hydatid cyst was removed totally. The clinical presentation, diagnosis and surgical treatment of this rare case of spinal hydatid disease is discussed, and all available cases of primary extradural hydatid cyst reported in the literature are presented. (+info)
MR Imaging in Wegener granulomatosis of the spinal cord.
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Wegener granulomatosis is a multisystemic disorder characterized by necrotizing vasculitis that primarily involves the respiratory tract. The orbits, heart, skin, joints, and nervous system are frequently involved. We describe the MR imaging findings of Wegener granulomatosis in the cervical spine and correlate them with the histopathologic features. MR imaging showed epidural liquid masses surrounded by granulomatous masses that compressed the cervical myelin from behind. (+info)
Delayed gadolinium enhancement in epidural space of the cervicothoracic spine in a patient with spontaneous intracranial hypotension.
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Spontaneous intracranial hypotension (SIH) due to a spinal cerebrospinal fluid leak is a rare but increasing cause of postural headache. Its extravasated epidural fluid collection tends to be non-enhanced or mildly enhanced on enhanced magnetic resonance (MR) imaging. The mild enhancement of the epidural fluid in SIH is usually attributed to fenestrated neovascularization provoked by an inflammatory component, such as blood, of the fluid collection. In this report, we present a case of SIH with a prominent delayed enhancement of the spinal epidural fluid collection on MR imaging. Subsequent vertebral angiography revealed that this delayed enhancement was related to contrast extravasation from a torn anterior meningeal branch of the right vertebral artery. Therefore, we suggest that contrast extravasation from a torn meningeal vessel may be a possible cause of the enhancement in the spinal epidural fluid of SIH. (+info)