Presentation
Progressive weakness and paralysis. History of trauma since 3 years spinal surgery.
Patient Data
An area of hyperintense T2/STIR signal intensity estimated at 7 x 4 mm in the sagittal plane in the spinal cord, at the level of C4 vertebral body, extending anteroposteriorly and associated with cord atrophy at this level consistent with myelomalacia from previous insult.
Previous surgery from C3 to C5 levels.
The spinal cord is tethered to the posterior aspect of the spinal canal at this level.
At the same level, a 4.7 x 4.4 x 2.8 cm (CC x Transverse x AP) hypointense T1, hyper intense T2/STIR cystic lesion is noted in the right posterior aspect of the neck soft tissues, in the inter-muscular plane, extending to the level of C2-C3 disc. It is insinuating between the right posterior paraspinal muscles with a beak-like extension in its inferomedial aspect reaching the right posterolateral level of the right C5 lamina. It shows a possible incomplete tract with the right posterior epidural space.
Early disc dehydration is noted from C3-C4 to C5-C6.
Otherwise the alignment is good.
No disc herniation.
The rest of the spinal cord has normal contour and signal intensity characteristics.
Case Discussion
This case demonstrates typical features of post traumatic myelomalacia at the level of C4 with posteriorly tethered spinal cord associated with a 4.7cm right posterior neck pseudomeningocele. No visible direct communication with the dural space, likely due to old probably healed dural tear.
The case is contributed by Dr Vera Ghattas Yazbeck and Dr Joe Ghattas Yazbeck.
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