Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Nov;267(11):3421-3424.
doi: 10.1007/s00415-020-10247-1. Epub 2020 Oct 3.

Case report of a cervical myelomalacia caused by a thoracolumbar intradural disc herniation leading to intracranial hypotension

M Ueberschaer  1 , M Patzig  2 , K Mueller  3 , J Schwarting  4 , R Trabold  4 , J-C Tonn  4
Affiliations
Case Reports

Case report of a cervical myelomalacia caused by a thoracolumbar intradural disc herniation leading to intracranial hypotension

M Ueberschaer et al. J Neurol. 2020 Nov.

Abstract

A 50-year-old patient was admitted with symptoms of intracranial hypotension. MRI revealed a cervical myelomalacia caused by engorged epidural veins leading to a stenosis of the spinal canal. This condition is rarely described in patients with hydrocephalus and ventricular shunts suffering from chronic overdrainage. However, the reason in this patient was a CSF leak caused by an intradural disc herniation at T12/L1. After surgery, symptoms resolved and the cervical myelomalacia and the swollen epidural veins disappeared on postoperative MRI. In patients with engorged cervical epidural veins without a ventricular shunt, a CSF leak has to be considered.

Keywords: CSF leak; Case report; Intracranial hypotension; Intradural disc herniation; Myelomalacia.

PubMed Disclaimer

Conflict of interest statement

There is no conflict of interest with any of the authors.

Figures

Fig. 1
Fig. 1
a Bilateral subdural hygromas in T2 weighted MRI (arrow); b significantly improved hygromas according to postoperative MRI
Fig. 2
Fig. 2
a Preoperative myelomalacia (arrows) at C3 in sagittal STIR-sequences and axial T2 weighted MRI; b Preoperative CE-MRI showing the prominent epidural veins leading to a spinal cord compression (arrows); c Normal epidural space without evidence of persisting myelomalacia at C3 according to the sagittal postoperative STIR- and axial T2 weighted MRI
Fig. 3
Fig. 3
a, b Sagittal and axial CISS MRI shows the discogenic spur at T12/L1(arrow); c CT-myelography with epidural contrast-pooling and right-sided ventromedial contrast agent extravasation
Fig. 4
Fig. 4
a Discogenic spur perforating the dural sac; b the spur after seperation from the dura; c final result after dural suture and application of a fibrin sponge (Tachosil)
See this image and copyright information in PMC

References

    1. Barbanera A, Serchi E, Fiorenza V, Nina P, Andreoli A. Giant calcified thoracic herniated disc: considerations aiming a proper surgical strategy. J Neurosurg Sci. 2009;53:19–25. - PubMed
    1. Beck J, Ulrich CT, Fung C, Fichtner J, Seidel K, Fiechter M, Hsieh K, Murek M, Bervini D, Meier N, Mono ML, Mordasini P, Hewer E, Z'Graggen WJ, Gralla J, Raabe A. Diskogenic microspurs as a major cause of intractable spontaneous intracranial hypotension. Neurology. 2016;87:1220–1226. doi: 10.1212/WNL.0000000000003122. - DOI - PubMed
    1. D'Andrea G, Trillo G, Roperto R, Celli P, Orlando ER, Ferrante L. Intradural lumbar disc herniations: the role of MRI in preoperative diagnosis and review of the literature. Neurosurg Rev. 2004;27:75–80. doi: 10.1007/s10143-003-0296-3. - DOI - PubMed
    1. Epstein NE, Syrquin MS, Epstein JA, Decker RE. Intradural disc herniations in the cervical, thoracic, and lumbar spine: report of three cases and review of the literature. J Spinal Disord. 1990;3:396–403. - PubMed
    1. Fiechter M, Ott A, Beck J, Weyerbrock A, Fournier JY. Intradural non-calcified thoracic disc herniation causing spontaneous intracranial hypotension: a case report. BMC Surg. 2019;19:66. doi: 10.1186/s12893-019-0527-3. - DOI - PMC - PubMed