Weekly Case

Title : case 345

Age / Sex : 72 / F


Chief complaint: Left foot drop (abrupt onset)

1) What is your impression? Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Courtesy: 권종원(Jong Won Kwon), 삼성서울병원(Seoul Samsung Hospital)


Diagnosis:

Intradural disc herniation



Discussion


       Operative findings: ventral exophytic IDEM mass, consistency soft, low vascularity


      






Superior







Lt







Rt







Inferior


       Pathologic report: Degenerated hyaline cartilage


       Diagnosis: Intradural disc herniation


 


       151 cases have been reported


       Locations


      Lumbar ; 92 % (L4-L5 ; 55 %, L3-L4 ; 16 %)


      Thoracic ; 5 %


      Cervical ; 3 %


       Average age of onset ; 50~60 years old


       Hypotheses


      Adhesions between the PLL and the ventral wall of the dura mater, due to some local inflammations


      Congenital union between the PLL and the dura mater


       Image findings


      Herniated discs appear as beak-like appearance, homogeneously isointense lesions on T1- and T2-WI


      After the contrast administration, lesions develop a characteristic peripheral ring enhancement (vascular granulation tissue)


      Discontinuity of PLL & dural layer


       Differential diagnosis


      Tumours: Meningioma, Neurinoma, Schwannoma


      Epidural migration of herniated disc: Continuity of dural layer


       References


1.     Chan et al. cliniccal molecular medicien 3(1):10-13, 2012


2.     SK Jain et al. Turkish neurosurgery 2013, vol:23, NO:3, 389-391


 



Correct Answer
Name Institution
이름:소속병원
Total Applicants: 11
Correct answers: 6
이지현: 삼성서울병원
윤지영: 삼성서울 병원
조신영: 웰튼병원
김완태: 중앙보훈병원
김인환: 전주우리들병원
윤성종: 강동경희대병원

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