Weekly Case

Title : Case 686

Age / Sex : 63 / M


Chief complaint : Voiding difficulty, left posterior thigh, calf, and heel pain


What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 
김현수 (Hyun Su Kim), 삼성서울병원 (Samsung medical center)


Diagnosis:

Dural ectasia in ankylosing spondylitis



Discussion


Findings:


Bamboo spine with ankylosis of facet joints and sacroiliac joints.


Dural ectasia with arachnoidal diverticula formation.


Adhesion of nerve roots within the diverticula


Bone erosions at the anterior aspect of vertebra posterior elements


 Differential Diagnosis:


Meningocele, Arachnoid cyst


 


Diagnosis:  


Dural ectasia in ankylosing spondylitis


 


Discussion:


Dural ectasia:


- Enlarged spinal dural sac usually involving the lumbosacral regions where the cerebrospinal fluid pressure is greatest


- Marfan syndrome, neurofibromatosis Type I, Ehlers–Danlos syndrome and long-standing ankylosing spondylitis


 


Dural ectasia in ankylosing spondylitis (AS):


- In long-standing AS, the inflammatory process may extend from the paraspinous ligaments to the dura mater, resulting in adhesion of the dura mater to the surrounding structures that reduce the compliance and elasticity of the lower dural sac and its ability to dampen the fluctuations in CSF pressure


- Exact prevalence of dural ectasia in AS is still unknown


- Dilated dural sac with diverticula formation, adhesion of nerve roots within the diverticula can be seen


- “Empty dural sac” sign can be manifested by adhesion of all the nerve roots


- Bone erosion predominantly involves the posterior elements rather than the posterior aspect of vertebral bodies seen in the other conditions


- Efficacy of medical and surgical treatments are still controversial


 


References:


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


S Ha, B Son. Cauda Equina Syndrome Associated with Dural Ectasia in Chronic Anlylosing Spondylitis. J Korean Neurosurg Soc 56 (6) : 517-520, 2014


R Abello, M Rovira, MP Sanz, A Capdevila et al. MRI and CT of ankylosing spondylitis with vertebral scalloping. Neuroradiology 1988 30:272-275.


 



Correct Answer
Total applicants 30 Correct answers 23
Name Institution
윤유성 순천향대 부천병원, 전문의
최형인 군의관, 전문의
장민영 국민건강보험공단 일산병원, 전문의
이규정 국군대전병원, 전문의
조영민 전문의
조신영 전문의
김기욱 전문의
임윤진 단국대학교병원, 전공의
이동규 경인지방병무청, 전문의
최수연 전문의
전인환 전문의
박선영 한림대학교 성심병원, 전문의
김동언 서울아산병원, 전문의
이혜란 전문의
김형민 연세의대 강남세브란스병원, 전문의
이혜원 전공의
권기언 서울아산병원, 전문의
강지희 전문의
문경일 전남대학교병원, 전공의
백승진 분당차병원, 전공의
이승보 서울아산병원, 전문의
김성진 365병원, 전문의
심상우 서울아산병원, 전문의
Semi-Correct Answer
Total applicants 30 Semi-Correct answers 7
여현정 전문의
이진영 전문의
이민욱 충남대학교병원, 전문의
최은지 전공의
김동수 전공의
김현진 서울성모병원, 전공의
변성환 전문의


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