case_images: PMC4750322_01
case_images: PMC4750322_02
case_images: PMC4750322_03
case_images: Sagittal T2W magnetic resonance imaging cervical spine in neutral position (a) shows reversal of cervical spine lordosis with intramedullary hyperintensity extending from C5 to C7 level and (b) in flexion shows anterior displacement of the dorsal dura from C4 to C7 levels
case_images: JNRP-7-164-g001.jpg
case_images: PMC4750322_03_JNRP-7-164-g001.jpg
case_images: F1
case_images: Magnetic resonance imaging in neutral position revealed loss of cervical lordosis with abnormal intramedullary hyperintensity extending from C5 to C7 level in T2W sagittal images [Figure 1a].
case_images: Contrast enhanced T1 sagittal in flexion position (a) shows enhancement of the posterior epidural space which was not seen on the neutral position of neck (b)
case_images: JNRP-7-164-g002.jpg
case_images: PMC4750322_03_JNRP-7-164-g002.jpg
case_images: F2
case_images: T1W sagittal images [Figure 2a] which was due to engorged posterior epidural venous plexus. These findings were not appreciated in the scan in the neutral position [Figure 2b].
case_images: (a) Axial T2W magnetic resonance imaging (MRI) in neutral position shows with asymmetric cord atrophy predominantly on right side and abnormal hyperintensity at C5-C6 level on T2W axial images. (b and c) Sagittal T2W and axial MRI in flexion position shows anterior displacement of the dorsal dura with flow voids seen in the posterior epidural space
case_images: JNRP-7-164-g003.jpg
case_images: PMC4750322_03_JNRP-7-164-g003.jpg
case_images: F3
case_images: T2W axial images [Figure 3a]. This raised a suspicion for Hirayama disease and MRI was repeated in flexion position which revealed anterior displacement of the dorsal dura with flow voids seen in the posterior epidural space [Figure 3b and c].
case_images: (a) Sagittal T2-SPACE magnetic resonance imaging (MRI) Cervical spine in neutral position shows of straightening of cervical spine with segmental cord atrophy and intramedullary hyperintensity at C6-C7 level; note the "sand watch" appearance in neutral position with normal cord architecture above and below the atrophy. (b) In flexion position shows multiple large flow voids in the cervico-dorsal posterior epidural space which shows enhancement in postcontrast sagittal T1W MRI (c)
case_images: JNRP-7-164-g004.jpg
case_images: PMC4750322_03_JNRP-7-164-g004.jpg
case_images: F4
case_images: MRI of the cervical spine in neutral position shows cord atrophy and intramedullary hyperintensity at C6-C7 level [Figure 4a]. MRI repeated in flexion position shows multiple large flow voids in the cervico-dorsal posterior epidural space [Figure 4b] which shows enhancement in postcontrast sagittal T1W MRI [Figure 4c]. These perimedullary flow voids were not seen in the neutral position which were clearly evident in the flexion position on T2-SPACE sequence and may also obviate the need for contrast examination.