Anterior (ventral) cord herniation
Updates to Case Attributes
Non-traumatic thoracic spinal cord herniation is more common among the women (M/F ratio 3:2) with a wide age range of presentation, 22-71 years. The most frequently described clinical presentation is Brown-Séquard syndrome. However, the clinical presentation might be variable based on the area of the herniated cord, for example, progressive paraparesis with mid-line hernia compared to sensory disturbances with an anterolateral defect.
The lesion is usually limited to one or two thoracic spine segments, and it involves the area of physiologic kyphosis, typically between T4 to T7 vertebrae.
Differential diagnoses are extradural mass with cord compression and arachnoid cyst, which can be excluded by increased turbulence in the fluid just dorsal to the site of herniation as CSF flows freely through the defect. Also, disk herniation with cord tethering can be distinguished by “nuclear trail” sign, which is a linear CT hyperdensity or T1 hyperintensity due to calcified leakage of nucleus pulposus from a herniated disk.
Case contributed by Dr Lorne Rosenbloom, neuroradiology assistant professor of McGill University.
-<p>Non-traumatic thoracic spinal cord herniation is more common among the women (M/F ratio 3:2) with a wide age range of presentation, 22-71 years. The most frequently described clinical presentation is Brown-Séquard syndrome. However, the clinical presentation might be variable based on the area of the herniated cord, for example, progressive paraparesis with mid-line hernia compared to sensory disturbances with an anterolateral defect. </p><p>The lesion is usually limited to one or two thoracic spine segments, and it involves the area of physiologic kyphosis, typically between T4 to T7 vertebrae. </p><p>Differential diagnoses are extradural mass with cord compression and arachnoid cyst, which can be excluded by increased turbulence in the fluid just dorsal to the site of herniation as CSF flows freely through the defect. Also, disk herniation with cord tethering can be distinguished by “nuclear trail” sign, which is a linear CT hyperdensity or T1 hyperintensity due to calcified leakage of nucleus pulposus from a herniated disk.</p><p>Case contributed by Dr Lorne Rosenbloom, neuroradiology assistant professor of McGill University.</p>- +<p> </p><p>Case contributed by Dr Lorne Rosenbloom, neuroradiology assistant professor of McGill University.</p>