Dorsal arachnoid web - scalpel sign

Case contributed by Dr Christine Goh

Presentation

Asymptomatic patient.

Patient Data

Age: 60 years
Gender: Female
MRI

MRI thoracic spine

Focal ventral displacement of the upper thoracic cord to abut the anterior dura, without clear herniation of cord through a dural defect. The posterior CSF space is focally enlarged, with preservation of normal CSF flow artifact.  Increased cord T2 signal is identified just above the focal cord of compression.

Annotated image

The shape of the cord distortion (arrow) resembles a scalpel blade, the 'scalpel sign' (arrow) that suggests a dorsal arachnoid web. 

Case Discussion

The shape of the cord distortion resembles a scalpel blade, the 'scalpel sign' that suggests a dorsal arachnoid web. An often associated finding that is not present in this case is syringomyelia, thought to be due to alterations in CSF flow.

The imaging differential diagnosis would be ventral cord herniation or adhesion. When the cord is closely apposed to the anterior dura, these conditions can be difficult to differentiate.

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Case information

rID: 34575
Published: 15th Mar 2015
Last edited: 23rd Aug 2019
Inclusion in quiz mode: Included

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