JRCR - Journal of Radiology Case Reports JRCR - Journal of Radiology Case Reports
Discussion started by Sunil Jeph 2 months ago

 

66-year-old caucasian male presented with left arm numbness and tingling which started from the neck down and resolved soon after he came to the emergency room. Past medical history was significant for cervical spine fusion surgery about 40 years back, complicated by acute epidural hematoma.He was admitted as a TIA work up during which his neck imaging was concerning for significant spinal stenosis at C3-C5. He underwent CT Myelogram which was consistent with pseudo-meningocele. Neurosurgery was consulted, who recommended no aggressive treatment as the pseudo-meningocele seemed chronic. He was later discharged with follow up with neurology and neurosurgery.

 

Figure. 1: Myelogram: Planar (A) Myelogram shows contrast extravasation outside the thecal sac (white arrow). Sagittal (B) and axial (C) CT images of the neck show contrast filling into the pseudo-meningocele pouch (white arrow) causing extrinsic compression of the spinal cord causing flattening of the spinal cord (black arrow).  

 

 

Figure. 2: T2 weighted sagittal (A) and axial (B) images of the cervical spine show fluid signal in the pseudo-meningocele pouch causing severe spinal cord compression (arrow) resulting in edema in the proximal and distal  Spinal cord.

 

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Holger Spittank
Holger Spittank
Hi everybody! Although mentioned for the past history of the patient there is no evidence for "spinal fusion" in the pictures (figures 1 / 2)! X-Ray lateral shows hight reduction of the segment C5 / 6 - this is usually the cause of "numbness and tingling" as reported by thousands of patients and in most of the cases and as it is of "functional origin" it could be resolved by manual medical care / manual therapy.. Clinically there might by no connection between the detected pseudo-meningocele and the neurological symptoms... . good idea not to forward for surgery!
2 months ago
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