Presentation
Significant fall while skiing weeks ago. Conservative management at the time. Now new myopathic signs. Hoffmann's sign positive and poor balance.
Patient Data
C4/5: Uncovertebral arthropathy with disc osteophyte complex and superimposed central disc protrusion resulting in severe canal stenosis and bilateral neural exit foraminal stenosis. Subtle high T2 signal in the cord above this level is localized to the dorsal columns and likely represents Wallerian degeneration.
C3/4, C5/6 and C6/7: moderate degenerative change.
Case Discussion
Wallerian degeneration is most frequently seen in the brain, particularly involving the corticospinal tracts. The same process is, however, seen in the spinal cord. The direction of involvement will depend on whether the dorsal columns are involved (degeneration will appear above the level of injury) or the anterior columns (degeneration will appear below the level of injury).
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