Presentation
Quadriparesis
Patient Data
Cervical spine
Significant thickening and ossification of posterior longitudinalligament is seen from C2 to C3 levels, causing severe compression of cord. Intramedullary hyperintensity is seen from C1-2 to C3-4 levels.
Thoracic spine
Significant thickening / ossification of ligamentum flavum is seen at T10-11 level, causing mild to moderate compression of cord. Intramedullary hyperintensity is seen from T9-10 to T10-11 levels.
Multilevel thickening / ossification of posterior longitudinal ligament and ligamentum flavum seen, causing mild to moderate compression of ventral, dorsal thecal sac, indentation of surface of cord and compression of neural foramina at places.
Reduced signal intensity is seen involving all visualized bones on all sequences.
Lumbar spine and sacroiliac joints
Apart from degenerative spondylotic changes, there is reduced signal intensity of all visualized bones on all sequences.
CT of cervical spine of the same patient as above shows ossification of posterior longitudinal ligament causing centrl canal narrowing, increased density of all visualized bones suggesting osteosclerosis and multiple other calcific enthesitis.
Case Discussion
Reduced signal intensity of the bones on MRI corresponds to the increased density on CT and suggests diffuse osteosclerosis. This, along with thickening/ ossification of posterior longitudinal ligament and ligamentum flavum suggests likelihood of fluorosis. The patient belongs to a area that has endemic high fluorine content in the water.
The quadriparesis can be explained by cervical compressive myelopathy. Compressive myelopathy is also seen in thoracic spine.
Unable to process the form. Check for errors and try again.