Ventral dural defect with spinal cord herniation

Case contributed by Dr Andrew Lawson

Presentation

Progressive left lower limb weakness over several months. Treated as multiple sclerosis, but has not shown improvement. No evidence of demyelination in the brain.

Patient Data

Age: 28
Gender: Female

There is a focal contour change, "kink", at the T5 cord, with the cord flattened against the left side of the posterior vertebral body. At this location, there is an ill defined focus of T2 hyperintensity in the left cord. Normal CSF flow signal noted posterior to the cord at this level, and there is no posteriorly directed mass effect on the posterior thecal sac to favour a posterior arachnoid cyst. There is anterior wedging of the T5 vertebral body with 20% reduced height. There is also a wedge compression of the T7 vertebral body.

Conclusion: Appearance is in keeping with cord herniation related to a ventral dural defect, with a small focus of myelopathy. With the T2 vertebral wedging, this could be post traumatic in etiology.

Case Discussion

The differential for this appearance includes:

  1. ventral cord herniation (favored)
  2. dorsal thoracic arachnoid web
  3. spinal arachnoid cyst

The patient went on to have a laminectomy and a ventral dural defect was confirmed and repaired. 

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Case information

rID: 26739
Case created: 6th Jan 2014
Last edited: 22nd Nov 2016
Inclusion in quiz mode: Included

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