Long-term course of anterior spinal cord herniation presenting with an upper motor neuron syndrome: Case report illustrating diagnostic and therapeutic implications

Regensburger M, Schlachetzki J, Klekamp J, Dörfler A, Winkler J (2020)

Publication Type: Journal article

Publication year: 2020

Journal

Book Volume: 20

Article Number: 321

Journal Issue: 1

DOI: 10.1186/s12883-020-01891-1

Abstract

Background: Anterior spinal cord herniation (aSCH) is a rare cause of myelopathy which may present as pure motor syndrome and mimic other degenerative diseases of the spinal cord. In slowly progressive cases, diagnosis may be impeded by equivocal imaging results and mistaken for evolving upper motor neuron disease. As early imaging studies are lacking, we aimed to provide a detailed description of imaging and neurophysiology findings in a patient with aSCH, focusing on the early symptomatic stages. Case presentation: We here present the case of a 51-year old male patient with an episode of pain in the right trunk and a normal spinal MRI. After a symptom-free interval of 8 years, spasticity and paresis evolved in the right leg. There was subtle ventral displacement and posterior indentation of the thoracic spinal cord on MRI which, in retrospect, was missed as an early sign of aSCH. After another 3 years, symptoms spread to the left leg and a sensory deficit of the trunk became evident. Follow-up MRI now clearly showed an aSCH. Neurosurgical intervention consisted of remobilization of the herniated spinal cord and patch closure of the dura defect. Over the following years, motor and sensory symptoms partially improved. Conclusions: The history of this patient with aSCH illustrates the importance of careful longitudinal clinical follow-up with repeated imaging studies in progressive upper motor neuron syndromes. Specific attention should be paid to a history of truncal pain and to MRI findings of a ventrally displaced spinal cord. Neurosurgical intervention may halt the progression of herniation.

Authors with CRIS profile

Involved external institutions

Christliches Krankenhaus Quakenbrück gGmbH Germany (DE)

How to cite

APA:

Regensburger, M., Schlachetzki, J., Klekamp, J., Dörfler, A., & Winkler, J. (2020). Long-term course of anterior spinal cord herniation presenting with an upper motor neuron syndrome: Case report illustrating diagnostic and therapeutic implications. BMC Neurology, 20(1). https://dx.doi.org/10.1186/s12883-020-01891-1

MLA:

Regensburger, Martin, et al. "Long-term course of anterior spinal cord herniation presenting with an upper motor neuron syndrome: Case report illustrating diagnostic and therapeutic implications." BMC Neurology 20.1 (2020).

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