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Progressive post-traumatic myelopathy presenting with magnetic resonance imaging snake-eye appearance
The Spine Journal 13 (2013) 830
Progressive post-traumatic myelopathy presenting with magnetic resonance imaging snake-eye appearance A 50-year-old man was admitted for the progressive onset of neck pain, limbs paresthesias, numbness, and weakness greater in the arms, in the last 6 years. The patient had no significant medical history, with the exception of a cervical spine hyperextension/hyperflexion injury that occurred 10 years before and was overcome without known clinical consequences. Sensory and motor nerve conduction studies of upper and lower limbs were normal. Electromyography
demonstrated high-amplitude and long-duration motor unit potentials in all muscles of upper limbs, with fibrillation potentials and positive sharp waves only in the left triceps muscle (C6- to C7-innervated muscle). No fasciculation potentials were evident. Electromyography study of lower limb muscles was normal. No disturbances in the function of cognitive and cranial nerves were found. The cervical spine magnetic resonance imaging examination showed spinal cord bilateral T2 hyperintensity at the C4–C6 level and a complete tear of the ligamentum flavum at the C4–C5 level. The cervical spine X-ray confirmed spinal instability (Figure). The clinical and neuroradiological findings were indicative of progressive posttraumatic myelopathy with snakeeye appearance and without spinal cord cystic cavity [1,2] associated with spinal instability. References [1] Falcone S, Quencer RM, Green BA, et al. Progressive posttraumatic myelomalacic myelopathy: imaging and clinical features. AJNR Am J Neuroradiol 1994;15:747–54. [2] Mizuno J, Nakagawa H, Inoue T, Hashizume Y. Clinicopathological study of "snake-eye appearance" in compressive myelopathy of the cervical spinal cord. J Neurosurg 2003;99(2 Suppl):162–8.
Carlo A. Mallio, MDa Mario Tombini, MDb Yuri Errante, MDa Bruno Beomonte Zobel, MDa,c Carlo C. Quattrocchi, MD, PhDa,c a Diagnostic Imaging Center for Integrated Research (CIR) Universita Campus Bio-Medico di Roma via Alvaro del Portillo 21, Rome 00128, Italy b Neurology, Center for Integrated Research (CIR) Universita Campus Bio-Medico di Roma via Alvaro del Portillo 21, Rome 00128, Italy c Radiology, Fondazione San Raffaele Via Gaetano di Biasio, 1, Cassino (FR) 03043, Italy Figure. Progressive posttraumatic myelopathy: T2 hyperintense ‘‘snakeeye appearance’’ lesion located within the spinal gray matter from the C4 to C6 level (Top Left and Bottom, arrows). Complete tear of the ligamentum flavum at the C4–C5 level (Top Left, arrowhead). Vertebral misalignment (Top Right) and facet subluxation at the C4–C5 level (Top Right, arrow).
1529-9430/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.02.044
FDA device/drug status: Not applicable. Author disclosures: CAM: Nothing to disclose. MT: Nothing to disclose. YE: Nothing to disclose. BBZ: Nothing to disclose. CCQ: Nothing to disclose.
Progressive post-traumatic myelopathy presenting with magnetic resonance imaging snake-eye appearance A 50-year-old man was admitted for the progressive onset of neck pain, limbs paresthesias, numbness, and weakness greater in the arms, in the last 6 years. The patient had no significant medical history, with the exception of a cervical spine hyperextension/hyperflexion injury that occurred 10 years before and was overcome without known clinical consequences. Sensory and motor nerve conduction studies of upper and lower limbs were normal. Electromyography
demonstrated high-amplitude and long-duration motor unit potentials in all muscles of upper limbs, with fibrillation potentials and positive sharp waves only in the left triceps muscle (C6- to C7-innervated muscle). No fasciculation potentials were evident. Electromyography study of lower limb muscles was normal. No disturbances in the function of cognitive and cranial nerves were found. The cervical spine magnetic resonance imaging examination showed spinal cord bilateral T2 hyperintensity at the C4–C6 level and a complete tear of the ligamentum flavum at the C4–C5 level. The cervical spine X-ray confirmed spinal instability (Figure). The clinical and neuroradiological findings were indicative of progressive posttraumatic myelopathy with snakeeye appearance and without spinal cord cystic cavity [1,2] associated with spinal instability. References [1] Falcone S, Quencer RM, Green BA, et al. Progressive posttraumatic myelomalacic myelopathy: imaging and clinical features. AJNR Am J Neuroradiol 1994;15:747–54. [2] Mizuno J, Nakagawa H, Inoue T, Hashizume Y. Clinicopathological study of "snake-eye appearance" in compressive myelopathy of the cervical spinal cord. J Neurosurg 2003;99(2 Suppl):162–8.
Carlo A. Mallio, MDa Mario Tombini, MDb Yuri Errante, MDa Bruno Beomonte Zobel, MDa,c Carlo C. Quattrocchi, MD, PhDa,c a Diagnostic Imaging Center for Integrated Research (CIR) Universita Campus Bio-Medico di Roma via Alvaro del Portillo 21, Rome 00128, Italy b Neurology, Center for Integrated Research (CIR) Universita Campus Bio-Medico di Roma via Alvaro del Portillo 21, Rome 00128, Italy c Radiology, Fondazione San Raffaele Via Gaetano di Biasio, 1, Cassino (FR) 03043, Italy Figure. Progressive posttraumatic myelopathy: T2 hyperintense ‘‘snakeeye appearance’’ lesion located within the spinal gray matter from the C4 to C6 level (Top Left and Bottom, arrows). Complete tear of the ligamentum flavum at the C4–C5 level (Top Left, arrowhead). Vertebral misalignment (Top Right) and facet subluxation at the C4–C5 level (Top Right, arrow).
1529-9430/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.02.044
FDA device/drug status: Not applicable. Author disclosures: CAM: Nothing to disclose. MT: Nothing to disclose. YE: Nothing to disclose. BBZ: Nothing to disclose. CCQ: Nothing to disclose.