[Idiopathic spinal cord herniation. Presentation of a new case and review of the literature].
BACKGROUND
Idiopathic herniation of the spinal cord is a rarely diagnosed condition. It is important since this cause of paraparesis is potentially curable if diagnosis is made early. Our aim is to report a new case, review the relevant literature, describe the radiological findings and consider the etiopathogenic findings.


METHODS
We report the case of a 56 year old man with increasing difficulty in walking attributed to stenosis of the lumbar spinal canal, which did not improve after laminectomy. On examination he had sensory and motor deficits compatible with the Brown-Séquard syndrome. Dorsal MR showed ventral displacement of the thoracic spinal cord with disappearance of the anterior subarachnoid space together with a posterior arachnoid cyst at the same site. A further operation was done at the same place and the cyst removed. However, it was impossible to free the spinal cord since there was severe spinal arachnoiditis. The patient made little improvement.


CONCLUSIONS
Herniation of the spinal cord is a rarely diagnosed condition. After careful study of the literature it seems that all patients present in a similar manner. Clinically there is a disorder of gait compatible with the Brown-Séquard syndrome. On MR there is sudden ventral displacement of the thoracic spinal cord, associated in some cases with an arachnoid cyst. When surgery is effective there is great improvement, so this diagnosis should be remembered in all cases of progressive paraparesis.
Berbel
A
A
Servicio de Neurología, Hospital 12 de Octubre, Madrid, España. aberbel@yahoo.com
Porta-Etessam
J
J
Martínez-Salio
A
A
Pérez-Martínez
D A
DA
Sáiz-Díaz
R A
RA
Rivas
J J
JJ
Ruiz
J
J
D000368:Aged; D016080:Arachnoid Cysts / Q000150:complications* / Q000601:surgery; D001100:Arachnoiditis / Q000150:complications; D018437:Brown-Sequard Syndrome / Q000209:etiology*; D003937:Diagnosis, Differential; D006547:Hernia / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D059685:Herniorrhaphy; D006801:Humans; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000209:etiology*; D011859:Radiography; D013118:Spinal Cord Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013130:Spinal Stenosis / Q000175:diagnosis; D013904:Thoracic Vertebrae