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Understanding Idiopathic Spinal Cord Herniation–A Comprehensive Review of Imaging and Literature

Pranav Sharma1Priti Soin2Mohamed Elbanan1Puneet Singh Kochar1
1Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, USA, 2Department of Pathology and Laboratory Medicine, Weill Cornell College of Medicine, New York, USA.
Date of Submission: 17-Feb-2019, Date of Acceptance: 19-Mar-2019, Date of Web Publication: 28-May-2019.
Corresponding Author:
Corresponding Author

Puneet Singh Kochar

Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, Connecticut, 06610, USA.
E-mail: drkochar.puneet@gmail.com

Corresponding Author:
Corresponding Author

Puneet Singh Kochar

Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, Connecticut, 06610, USA.
E-mail: drkochar.puneet@gmail.com

DOI: 10.25259/JCIS-25-2019 Facebook Twitter Google Linkedin

ABSTRACT


Idiopathic spinal cord herniation (ISCH) is displacement of spinal cord through a dural or arachnoidal defect. Most patients present with back pain or myelopathy, paresthesia, and sensory or motor weakness. Imaging findings include anterior displacement of the cord with possible kink, no filling defect on CT myelography, and no restricted diffusion/mass lesion on magnetic resonance imaging. Abrupt kink in the spinal cord or widened cerebrospinal fluid (CSF) space can be caused by a variety of reasons. The differential considerations include arachnoid web, intradural extramedullary epidermoid or arachnoid cyst, abscess or cystic schwannoma. We discuss the features, imaging, differentials, and treatment of ISCH as a rare cause of such kink in the cord. While reading such cases, a radiologist should include the location, segments involved, cord signal abnormality, visible defect, scalpel sign or C–sign, ventral cord kink, nuclear trail sign, the ventral CSF space preservation, or obliteration and the type.
Keywords: Spinal cord herniation, Idiopathic spinal cord herniation, Dural defect, Cord kink

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