Idiopathic Spinal Cord Herniation: Case Report and Review of the Literature

Idiopathic Spinal Cord Herniation: Case Report and Review of the Literature AbstractOBJECTIVE AND IMPORTANCEIdiopathic spinal cord herniation (ISCH) is a rare condition, reported in only 25 patients thus far, in which the thoracic cord is prolapsed through an anterior dural defect. It typically presents in middle age as either Brown-Sequard syndrome or spastic paraparesis.CLINICAL PRESENTATIONA 55-year-old woman initially presented at the age of 41 years with Brown-Séquard syndrome at the T8 disc space level on the left side. Investigations, including primitive magnetic resonance imaging, were deemed negative at that time. After a stepwise deterioration over 14 years, she presented again with spastic paraparesis and double incontinence, in addition to her previous spinothalamic dysfunction. Magnetic resonance imaging at this stage suggested either ISCH or a dorsal arachnoid cyst.INTERVENTIONThrough a T7-T8 laminectomy, a left-of-midline ISCH was identified and easily reduced by gentle cord traction. No dorsal arachnoid cyst was identified. The anterior dural defect was repaired with a XenoDerm patch (LifeCell Corp., Woodlands, TX). After surgery, there was improved motor and sphincter function. However, there was continued sensory disturbance.CONCLUSIONISCH is rare cause of thoracic cord dysfunction. Despite prolonged diagnostic delay, significant clinical improvement may be obtained with ISCH reduction and anterior dural repair. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Idiopathic Spinal Cord Herniation: Case Report and Review of the Literature

Idiopathic Spinal Cord Herniation: Case Report and Review of the Literature

Idiopathic Spinal Cord Hernia 1 1 2 9 that this leg had " d r a g g e d " o v e r the Idiopathic Spinal Cord Herniation: p re c e d in g w eeks. O n e x a m in a tio n , th ere w as m ild s p a sticity in the rig h t leg in Case Report and Review of the Literature ad d itio n to a s ig n ific a n t d e te r io r a tio n in the p re v io u s ly n o ted s p a s tic ity in h er left leg. T h e rest o f the e x a m in a tio n re ­ Laurence A.G. Marshman, F.R.C.S., Carl Hardwidge, F.R.C.S., m a in e d u n c h a n g e d . T h e re su lts o f all Suzanne C. Ford-Dunn, M .B., John S. Olney, F.R.C.R. in v e stig a tio n s, in c lu d in g a m a g n e tic r e s ­ o n a n c e im a g in g (M R I) scan , sp in a l a n ­ Departments of Neurosurgery (LAGM, CH, SCF-D) and Neuroradiology (JSO), giography, and com p u ted tom ography/ Hurstwood Park Neurological Centre, Princess Royal Hospital, West Sussex, England myelography, were reported to be normal. OBJECTIVE AND IMPORTANCE: Idiopathic spinal cord herniation (ISCH) is a Third admission rare condition, reported in only 2 5 patients thus far, in which the thoracic H er c o n d itio n a g a in r e m a in e d stab le cord is prolapsed through an an terior dural defect. It typically presents in until A p ril 1996, w h e n , in a d d itio n to middle age as either Bro w n -S e q ua rd syndrome or spastic paraparesis. her sp astic gait, fecal and u rin a r y in c o n ­ CLINICAL PRESENTATION: A 5 5 -y e a r-o ld w o m a n initially presented at the age tin en ce d e v e lo p e d . S h e also e x p e rie n c e d of 41 years with Bro w n -S e qu a rd syndrome at the T8 disc space level on the d y se sth e tic p a in in b o th legs, h er left leg felt " f a l s e ," an d th ere w a s an a s so cia te d left side. Investigations, including primitive magnetic resonance imaging, left fo o td ro p . O n e x a m in a tio n , s p a s tic ­ were deemed negative at that time. After a stepwise...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199905000-00112
Publisher site
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Abstract

AbstractOBJECTIVE AND IMPORTANCEIdiopathic spinal cord herniation (ISCH) is a rare condition, reported in only 25 patients thus far, in which the thoracic cord is prolapsed through an anterior dural defect. It typically presents in middle age as either Brown-Sequard syndrome or spastic paraparesis.CLINICAL PRESENTATIONA 55-year-old woman initially presented at the age of 41 years with Brown-Séquard syndrome at the T8 disc space level on the left side. Investigations, including primitive magnetic resonance imaging, were deemed negative at that time. After a stepwise deterioration over 14 years, she presented again with spastic paraparesis and double incontinence, in addition to her previous spinothalamic dysfunction. Magnetic resonance imaging at this stage suggested either ISCH or a dorsal arachnoid cyst.INTERVENTIONThrough a T7-T8 laminectomy, a left-of-midline ISCH was identified and easily reduced by gentle cord traction. No dorsal arachnoid cyst was identified. The anterior dural defect was repaired with a XenoDerm patch (LifeCell Corp., Woodlands, TX). After surgery, there was improved motor and sphincter function. However, there was continued sensory disturbance.CONCLUSIONISCH is rare cause of thoracic cord dysfunction. Despite prolonged diagnostic delay, significant clinical improvement may be obtained with ISCH reduction and anterior dural repair.

Journal

NeurosurgeryOxford University Press

Published: May 1, 1999

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