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)

Intradural disc herniation

Discussion

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

•      

•       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