• Neurosurgery · Jul 2012

    Review Case Reports

    Thoracic myelopathy due to an intramedullary herniated nucleus pulposus: first case report and review of the literature.

    • Sonia Teufack, Peter Campbell, Pranshu Sharma, Tim Lachman, Lawrence Kenyon, James Harrop, and Srinivas Prasad.
    • Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
    • Neurosurgery. 2012 Jul 1;71(1):E199-202.

    Background And ImportanceHerniation of intervertebral discs is relatively common. Migration usually occurs in the ventral epidural space; very rarely discs migrate in the subdural space. No cases of intradural intramedullary disc have been reported in humans.Clinical PresentationA case of a herniated intervertebral disc directly into the spinal cord parenchyma is presented. The patient presented with 2 weeks of progressive bilateral lower extremity numbness and weakness, saddle hypoesthesia, urinary dysfunction and gait disturbance. Spine magnetic resonance imaging (MRI) with gadolinium revealed a solitary well-defined intramedullary lesion (T7-T8 level) with ring enhancement and focal cord expansion with significant surrounding edema. Metastatic workup and neural axis imaging was negative. A thoracic laminectomy and myelotomy was performed; the lesion was pearlescent and well circumscribed. It was densely adherent to the ventral pia and gross totally removed. Pathology was consistent with nucleus pulposus.ConclusionIntradural intramedullary migration of a herniated intervertebral disc is extremely rare but should be considered in the differential. It may present in a variety of clinical scenarios, including thoracic myelopathy, and mimic intramedullary spinal cord tumor.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        

    hide…