Presentation
Progressive weakness of both hands with reduced power of finger grip. No abnormalities in lower limbs.
Patient Data
There is thinning of the lower cervical spinal cord (from C4 to C7 vertebral body level) with central high signal on T2 images at the lower cervical cord with further extension into the upper thoracic spine.
In flexion images there is anterior bulging of the posterior dura leading to prominent posterior dural space at the mentioned vertebral levels. Contrast enhancement of the posterior epidural space with subtle flow voids can be seen.
Enhancement of the posterior epidural space and anterior bulging of the posterior dura are shown here.
Case Discussion
Lower cervical cord atrophy, anterior bulging of the posterior dura and contrast enhancement of the posterior epidural space are the imaging hallmarks of this condition. In the correct clinical context, these features are diagnostic of Hirayama disease.
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