Braileanu Maria, Hoch Michael, Rincon Sandra, Weinberg Brent
Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Gray 271, Boston, MA 02114, USA.
Department of Radiology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Radiol Case Rep. 2021 Mar 20;16(5):1216-1219. doi: 10.1016/j.radcr.2021.02.039. eCollection 2021 May.
Hirayama disease is a cervical flexion myelopathy that typically causes upper extremity weakness in young male patients. We present two male patients (age 15 and 29) with MRI findings of thoracic ligamentous laxity similar in appearance to Hirayama disease. However, patients presented with atypical symptoms, specifically back pain and paresthesia of the upper and/or lower extremities, likely correlating to the abnormal thoracic spinal levels involved. Flexion/extension MRI sequences demonstrated the forward displacement of the dorsal dura and compression the thoracic cord with prominence of the posterior epidural space and venous plexus. Follow-up MRAs were negative for a spinal vascular malformation. Patients were managed conservatively with no surgical intervention. Clinical history, thoracic MRI, and follow-up flexion and angiographic imaging sequences may help confirm a diagnosis of Hirayama-like thoracic ligamentous laxity.
平山病是一种颈椎屈曲性脊髓病，通常导致年轻男性患者出现上肢无力。我们报告了两名男性患者（年龄分别为15岁和29岁），其MRI表现为胸段韧带松弛，外观与平山病相似。然而，患者表现出非典型症状，特别是背痛以及上肢和/或下肢感觉异常，这可能与受累的异常胸段脊髓节段有关。屈伸位MRI序列显示硬脊膜背侧向前移位，胸段脊髓受压，同时硬膜外间隙和静脉丛突出。随访的磁共振血管造影未发现脊髓血管畸形。患者接受保守治疗，未进行手术干预。临床病史、胸段MRI以及随访的屈伸位和血管造影成像序列可能有助于确诊类似平山病的胸段韧带松弛。
