Question:

Which of the following is True regarding anterior cord herniation?
1. Patients do not present with chest pain.
2. The dorsal subarachnoid space is not expanded.
3. The herniated cord is not attached to the dura.
4. The most common misdiagnosis is that of arachnoid cyst.
5. CSF flow pulsation artifacts are not seen dorsally in this condition.





Answer:

The correct answer for the question "Which of the following is True regarding anterior cord herniation?" is:

4. The most common misdiagnosis is that of arachnoid cyst.



Explanation
1. This is a recognized presentation. [Other presentations included spastic paresis, bowel or bladder sphincter dysfunction, isolated motor or sensory disturbance (as in the case of our patient), and chest pain.]

2. It is expanded. [On sagittal sections, an anterior C-shaped kink of the cord can be seen, with secondary expansion of the dorsal subarachnoid space.]

3. It is normally attached to the dura. [The other telltale sign is that on axial sections, the herniated cord is attached to the ventral dura mater, with no intervening CSF.]

4. This is the most commonly reported misdiagnosis in the literature. [The most common misdiagnosis in the literature has been to mistake the expanded dorsal subarachnoid space for an arachnoid cyst.]

5. They are a helpful diagnostic feature. [The presence of normal CSF pulsation artefact is another important diagnostic feature, since it implies unimpeded CSF flow.]



From the manuscript:
MRI findings in herniation of the spinal cord
Radiology Case. 2010 Oct; 4(10):1-5


This article belongs to the Neuro section.




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From the manuscript

MRI findings in herniation of the spinal cord

Free full text article: MRI findings in herniation of the spinal cord

Abstract
Herniation of the spinal cord is a rare condition that causes non specific neurological deficits that are often a diagnostic challenge to clinicians. Despite several reports in the neurosurgical literature, it is only recently that the imaging appearances of this condition have come to be recognised, due mainly to the widespread adoption of spinal MRI. It is important for radiologists to recognise the telltale MRI features of this condition, as several cases have undergone initial misdiagnosis, resulting in delayed treatment We present a case with typical imaging features to familiarise radiologists with this condition, as it is likely that more cases will come to the fore, with more spinal MRIs being performed.






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