Presentation
A history of tethered cord and diastematomyelia since childhood under follow-up.
Patient Data
- Normal kyphosis of the dorsal spine and lordosis of the lumbar spine is noted.
- Vertebral bodies show normal alignment and marrow signal intensities.
- The intervertebral discs show normal signal intensity. No focal protrusion or diffuse disc bulge is noted.
- There is evidence of a low-lying conus medullaris with the tip of the spinal cord ending at the L2 level.
- There is evidence of diastematomyelia in the lower dorsal cord.
- There is a syrinx located at the D11 level.
- There is evidence of a spina bifida which is a closed defect at the level of the sacrum.
- No evidence of intra/extra dural, intramedullary mass lesion is noted.
- Pre and paravertebral soft tissues are normal.
- The spinal canal dimensions are within normal limits.
IMPRESSION:
MRI features of a diastematomyelia type II with associated vertebral anomalies.
In these annotated images :
- Red arrows are pointing to a single dural sac containing both hemicords (Diastematomyelia).
- Green arrows are pointing to a hydromyelia.
Case Discussion
A 25-year-old female patient, diagnosed since childhood with tethered cord and diastematomyelia under follow-up. presented with non-specific symptoms and fewer neurological symptoms. This case illustrates a classic type of Type II diastematomyelia, showing a single dural sac and abnormal development of the lamina and spinous process.
MRI showed the spinal canal had a single dural sac and separated into two parts without a dividing septum/spur, the two halves of the spinal cord were asymmetrical starting from T12 to L2. A focal hydromyelia opposite T11and partially unfused laminae at the lower lumbar levels and completely unfused laminae at the sacral segments (spina bifida).
Diastematomyelia is a rare congenital malformation of the spinal cord and a new classification and term (‘split cord malformation, SCM) has two types of diastematomyelia
- Type I is due to the presence of spinal septa which can be bony or non-bony.
- In Type II patients (as our patient) there are no spinal septae and the two halves of the spinal cord were located within the same dural sac. This type has fewer symptoms, which explains why many adult patients with Type 2 diastematomyelia remain very active.
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