Two cases of anterior spinal hernia are presented. The medical literature is reviewed, the syndrome characterised, and its cause and treatment discussed. The patient is typically middle aged with a history of stepwise slowly progressive mid-thoracic anterior hemicord syndrome manifesting as hemianalgesia below the affected segment, followed by contralateral lower limb spasticity that develops into an asymmetric paraparesis with sparing of dorsal column sensation. Radiological investigation demonstrates an enlarged dorsal arachnoid space in association with an apparently focally narrowed thoracic cord, kinked towards the anterior dura. At operation the cord Figure1 Left; patient 1, preoperative Tl weighted spin echo sagittal MRI showingfocal anterior cord tethering at D4. Right; patient 2, preoperative Tl weighted spin echo sagittal MRI showingfocal anterior cord tethering at D8.
Until recently, idiopathic anterior spinal cord herniation was thought to be vanishingly rare. It is an increasingly recognized, readily treatable, condition causing progressive thoracic myelopathy. We have operated on five cases and know of two other patients locally who are as yet undecided on surgery. We are aware of several other unpublished cases in the UK. The syndrome presents typically in middle age with a history of stepwise slowly progressive mid-thoracic anterior hemicord dysfunction characterized by hemianalgesia below the affected segment followed by asymmetric lower limb hypertonia, with initial sparing of posterior column sensation, that progresses through paraparesis to complete paraplegia. The radiological findings, although subtle, are equally typical and surgical repair is easily effected. With increasing clinical and radiological awareness, we believe the apparent incidence of this condition will increase. Idiopathic anterior spinal cord hernia is more common than currently appreciated, and should be positively considered and excluded in every case of progressive thoracic cord dysfunction.
Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease characterized by the presence of osseous and cartilaginous submucosal nodules projecting into the tracheobronchial tree. Most cases are asymptomatic and discovered incidentally at post-mortem. We identified a case of TO on thoracic spiral CT and confirmed the diagnosis of bronchoscopy. This article reviews the imaging characteristics of TO, and shows the 3-D virtual bronchoscopic and multiplanar reconstruction appearances of TO.
Objectives: This study included a series of middle-aged male and female patients who presented with chronic anterior hemicord dysfunction progressing to paraplegia. Imaging of anterior thoracic cord displacement by either a dural adhesion or a dural defect with associated cord herniation is presented. Methods: This is a retrospective review of cases referred to a tertiary neuroscience centre over a 19-year period. Imaging series were classified by two experienced neuroradiologists against several criteria and correlated with clinical examination and/ or findings at surgery. Results: 16 cases were available for full review. Nine were considered to represent adhesions (four confirmed surgically) and four to represent true herniation (three confirmed surgically). In the three remaining cases the diagnosis was radiologically uncertain. Conclusion:The authors propose ''thoracic anterior spinal cord adhesion syndrome'' as a novel term to describe this patient cohort and suggest appropriate clinicoradiological features for diagnosis. Several possible aetiologies are also suggested, with disc rupture and inflammation followed by disc resorption and dural pocket formation being a possible mechanism predisposing to herniation at the extreme end of a clinicopathological spectrum. Anterior spinal cord hernia is a rare and potentially treatable cause of progressive anterior spinal cord syndrome. The cord prolapses through an anterior or anterolateral dural defect, resulting in a progressive, frequently asymmetrical, thoracic myelopathy. Patients typically present in middle age with slowly progressive neurological dysfunction relating to anterior hemicord dysfunction [1, 2]. The condition was described in 1973 by Cobb et al [3], with the first idiopathic case suggested by Wortzman et al [4] a year later; a number of case reports and small series have been published since. The exact causative mechanism has not been fully elucidated. The radiological findings of true herniation are well described but not widely recognised as the number of cases in world literature remains relatively small.In our clinical practice we have identified a number of patients who present with a clinical picture that is indistinguishable from patients with anterior spinal cord herniation and MRI demonstration of anterior cord deviation, but without imaging or surgical evidence of a true cord hernia. Based on this observation, we suspect that true hernia is positioned at the extreme end of a pathological spectrum; other cases of anterior cord deviation and wasting-possibly caused by focal vulnerability, deficiency of the anterior dura or anterior tethering of the cord-appear to present with similar clinical symptoms. Evidence in support of this assertion is the case reported by Ewald et al [5] demonstrating progressive development of an anterolateral T6 cord herniation on successive MRI examinations, with associated progression in clinical symptoms over a 2-year period prior to operative intervention. We propose that the association of thoracic myelopat...
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