title: Epidural varix at the cervicothoracic junction: unusual cause of quadriplegia: a case report.
abstract: METHODS
  A case report describing an unusual incident of quadriplegia in a young adult male caused by an epidural varix at the cervicothoracic junction.
  
  
  OBJECTIVE
  To report an unusual case of quadriplegia caused by an epidural varix at the cervicothoracic junction.
  
  
  BACKGROUND
  Epidural varices are dilated tortuous elongated veins inside the central canal. In degenerative spinal stenosis, these varices are a result of venous stagnation and contribute to the pathogenesis of radicular pain. In the absence of stenosis, primary varicosities develop as a result of dynamic obstruction to venous outflow during spinal movements. A primary epidural varix can produce neurologic deficit similar to a space occupying lesion within the spinal canal. The myeloradiculopathy is of a slow progressive nature.
  
  
  METHODS
  A young man presented with an acute onset flaccid quadriplegia in the absence of significant trauma. Magnetic resonance imaging revealed an extradural space occupying lesion at the cervicothoracic junction that was diagnosed as an isolated epidural varix during surgery.
  
  
  RESULTS
  No neurologic recovery occurred. Postoperative magnetic resonance imaging revealed a syrinx in the cervicothoracic cord.
  
  
  CONCLUSIONS
  In the absence of other precipitating factors, the cord injury was attributed to the epidural varix. A temporary impedance to the venous outflow with the increase in the venous pressure has been hypothesized as the mechanism of cord injury.
authors.affiliation: Department of Orthopedics, King Edward Memorial Hospital, Mumbai, India. mrbkemh@netscape.net
authors.forename: Mihir
authors.initials: M
authors.lastname: Bapat
authors.forename: Umesh
authors.initials: U
authors.lastname: Metkar
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D004824:Epidural Space / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011782:Quadriplegia / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging; D014648:Varicose Veins / Q000150:complications* / Q000000981:diagnostic imaging