imaging (MRI) showed a lesion with epicenter at the left side of the nasopharynx with extension into adjoining left sided nasal cavity, left sided paranasal sinuses (sphenoid, ethmoid, and maxillary sinuses) and left parasellar region [Figure 1]. The patient received external beam radiotherapy (EBRT) with a total dose of 60 Gy in 30 divided doses over a 6 weeks period. The radiation field comprised left side of nasopharynx, left nasal cavity and left maxillary antrum. Clinicoradiological follow-up showed no local residual lesion/recurrence. Eight years later, in 2012, this patient presented to the neurosurgical emergency with sudden onset severe headache, nausea and vomiting. Neck rigidity was present on examination. A plain computed tomography scan [Figure 2] showed SAH involving the perimesencephalic cisterns, sylvian cistern and along the tentorium (Fisher Grade 3). His Glasgow coma scale score was 15 and World Federation of Neurological Surgeons grade was Grade 1. A four vessel angiogram revealed six cerebral aneurysms. There was a fusiform terminal left internal carotid artery (ICA) aneurysm with extension in proximal A1 and proximal M1 segments of left anterior cerebral artery and middle cerebral artery (MCA). A saccular
BACKGROUND Cervical myelopathy is a common cause of major neurological disability. The purpose of our study was to evaluate the magnetic resonance imaging (MRI) features and identification of the possible causes of cervical myelopathy in patients after ruling out traumatic and neoplastic lesions. METHODS Patients of either sex, above the age of 12 years who were clinically diagnosed as nontraumatic cervical myelopathy were included in this study conducted in a tertiary centre of West Bengal over a period of 18 months. Later, we also excluded patients having neoplastic lesions detected by MRI. Following clinical examinations, selected patients underwent MRI of cervical spine in a 3 Tesla MR scanner to determine the aetiology of cervical myelopathy and to assess the morphology, location and extent of the causative lesion. Standard MRI sequences were used in different planes. Post contrast study was performed only in selected cases. This was an institution based descriptive study. RESULTS Forty-three patients of 14 to 80 years of age with a mean age of 48.5 years had nontraumatic and nonneoplastic causes contributing to cervical myelopathy. Nearly two-thirds of these patients were males and rest were females. Of the various nontraumatic and nonneoplastic causes, cervical spondylosis was by far the most common aetiology of cervical myelopathy, seen in nearly 58% of such patients. CONCLUSIONS We concluded that MRI was useful in lesion characterisation and depicting various causes of cervical myelopathy, thereby playing a very important role in management of these patients.
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