Weekly Case

Title : case 389

Age / Sex : 43 / M



Chief complaint: voiding difficulty, limping gait (known ankylosing spondylitis)

What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(
답안은 개만 보내주시기 바랍니다)


 


 


 


Courtesy: 채지원 (Jee won Chai), 서울특별시보라매병원 (SMG-SNU Boramae Medical Center)


Diagnosis:

Destructive dural ectasia in ankylosing spondylitis



Discussion


Findings:


Bamboo spine and ankylosis of facet joints


Dural ectasia with arachnoidal diverticula


Adhesion or herniation of nerve rootlets within the diverticula


Scalloping of the anterior aspect of vertebral posterior elements


 


Differential Diagnosis: Post-procedural change (Endoscopic partial laminectomy), Meningocele, Arachnoid cyst


 


Diagnosis: Destructive dural ectasia in ankylosing spondylitis


 


Discussion:


Destructive dural ectasia is a rare manifestation in patients with long-standing ankylosing spondylitis. Cauda equine syndrome can be accompanied by chronic inflammatory process in ankylosing spondylitis, which is spread from paraspinal ligaments to the dura matter and nerve rootlets, resulting in adhesion of dura to surrounding structures and arachnoiditis. Imaging findings are dilated dural sac with diverticula formation, adhesion or herniation of nerve rootlets within the diverticula, bone erosion at vertebral posterior elements. “Empty dural sac” sign can be produced by adhesion of all nerve rootlets.


 


References:


C-C Liu, Y-C Lin, C-P Lo et al. Cauda equina syndrome and dural ectasia: rare manifestations in chronic ankylosing spondylitis. Br J Radiol. Jun 2011; 84(1002): e123–e125.


 


Marijke Van Hoydonck, Kurt de Vlam, Rene Westhovens. Destructive Dural Ectasia of Dorsal and Lumbar Spine with Cauda Equina Syndrome in a Patient with Ankylosing Spondylitis. Open Rheumatol J. 2010; 4: 31–34.



Correct Answer
Name Institution
이름:소속병원
Total Applicants: 35
Correct answers:21
신윤상:인하대병원
김혜원:여의도 성모병원
김지민:순천향대 천안병원
류혜진:서울대병원
최현진:인하대병원
홍진호:인하대병원
박지원:대구 튼튼병원
김나희:인하대병원
김유진:인하대병원
우아름:인하대병원
한준구:인하대병원
최승희:분당서울대병원
길은경:순천향대 부천병원
이승현:세브란스병원
이광진:통영 적십자병원
이상윤:무척나은병원
김소희:창원 삼성병원
김성관:군국수도병원
최마리:예병원
주비오:세브란스병원
이선영:대림성모병원
Semi-correct answers:6
이혜란:서울아산병원
이지은:고든병원
이승훈:한양대병원
윤유성:순천향대 천안병원
조신영:웰튼병원
남경선:상계 백병원

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