title: Ventral longitudinal intraspinal fluid collection: Rare presentation as brachial amyotrophy and intracranial hypotension.
abstract: Ventral longitudinal intraspinal fluid collection (VLISFC) presenting as hand amyotrophy has been described only in a few cases and there are no reports on associated intracranial CSF hypovolemia (ICH). We describe the clinical and imaging findings of a case with combined brachial amyotrophy and ICH secondary to VLISFC.
  
  
  
  A 31 year old man presented with severe positional neck discomfort, radiating pain, progressive asymmetrical wasting and weakness of distal upper limbs. Contrast Magnetic Resonance Imaging (MRI) of the spine demonstrated a ventral extradural intraspinal fluid collection extending from upper border of C6 to lower border of T3 vertebra with pockets of dorsal collection. Three-dimensional constructive interference in steady state (CISS 3D) used in spinal imaging for identification of CSF leak corroborated with the extent seen on T2 sagittal sections; however, the site of the leak was not identified. After a year he developed disturbing postural headache which was relieved in recumbent position. Follow up MRI of brain was normal while spine demonstrated significant cervical cord atrophy and bilateral cord white matter hyperintensities. Conclusion / Clinical Relevance: We report this unusual case where local compression by VLISFC located at the cervical and upper thoracic level not only caused distal bi-brachial amyotrophy mimicking Hirayama disease but also led to secondary intracranial hypotension. An early identification and intervention could possibly have prevented the onset of ICH.
authors.affiliation: a Department of Neurology, National Institute of Mental Health and Neuro Sciences , Bangalore , India.|b Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences , Bangalore , India.
authors.forename: Veeramani
authors.identifier: 0000-0003-1158-0971
authors.initials: V
authors.lastname: Preethish-Kumar
authors.affiliation: a Department of Neurology, National Institute of Mental Health and Neuro Sciences , Bangalore , India.
authors.forename: Seena
authors.initials: S
authors.lastname: Vengalil
authors.affiliation: c Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences , Bangalore , India.
authors.forename: Sarbesh
authors.initials: S
authors.lastname: Tiwari
authors.affiliation: a Department of Neurology, National Institute of Mental Health and Neuro Sciences , Bangalore , India.|b Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences , Bangalore , India.
authors.forename: Kiran
authors.initials: K
authors.lastname: Polavarapu
authors.affiliation: a Department of Neurology, National Institute of Mental Health and Neuro Sciences , Bangalore , India.
authors.forename: M
authors.initials: M
authors.lastname: Netravathi
authors.affiliation: c Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences , Bangalore , India.
authors.forename: Aravinda Hanumanthapura
authors.initials: AH
authors.lastname: Ramalingaiah
authors.affiliation: a Department of Neurology, National Institute of Mental Health and Neuro Sciences , Bangalore , India.
authors.forename: Atchayaram
authors.initials: A
authors.lastname: Nalini
mesh_terms: D000328:Adult; D020968:Brachial Plexus Neuritis / Q000000981:diagnostic imaging / Q000473:pathology*; D065634:Cerebrospinal Fluid Leak / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D006801:Humans; D019585:Intracranial Hypotension / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000473:pathology*; D014897:Spinal Muscular Atrophies of Childhood / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: Brachial amyotrophy; Cerebrospinal fluid hypovolemia; MRI; Spontaneous intracranial hypotension; VLISFC; Ventral longitudinal intraspinal fluid collection