Myelomalacia at the posterior funiculus related to a ventral longitudinal intraspinal ﬂuid collection

BMJ Case Rep, 2016 · DOI: 10.1136/bcr-2016-214791 · Published: June 3, 2016

Neurology Spinal Disorders Research Methodology & Design

Simple Explanation

A man experienced paraesthesia (abnormal sensation) on one side of his body when twisting. This had been occurring for six months. An MRI revealed myelomalacia (spinal cord damage) in the cervical region and a ventral longitudinal intraspinal fluid collection (VLISFC) extending from the neck down to the lumbar area. A dural defect (tear in the membrane surrounding the spinal cord) was found, potentially related to a skiing accident 15 years prior, and is considered the underlying cause of the fluid collection and spinal cord damage.

Study Duration

6 months

Participants

A 48-year-old man

Evidence Level

Case Report

Key Findings

1
The patient presented with myelomalacia located in the posterior funiculus at C3 in addition to the anterior horn from C2 to C4.
2
Ventral longitudinal intraspinal fluid collection (VLISFC) was observed from the C2 to L2 vertebral levels.
3
A dural defect was identified at the intervertebral levels between C7 and T1.

Research Summary

This case report describes a patient with myelomalacia (spinal cord damage) in the posterior funiculus associated with a ventral longitudinal intraspinal fluid collection (VLISFC). The underlying cause was determined to be a dural defect, possibly from a past trauma, leading to cerebrospinal fluid leakage and the formation of the VLISFC. This is the first report to describe myelomalacia extending to the posterior funiculus in duropathy, in addition to the anterior horn.

Practical Implications

Diagnostic Awareness

Clinicians should be aware of duropathy as a potential cause of myelomalacia, especially when VLISFC is present.

Differential Diagnosis

Dural defects should be considered in the differential diagnosis of patients presenting with myelomalacia, multisegmental amyotrophy, spinal cord herniation, or craniospinal hypovolaemia.

Surgical Intervention

Surgical repair of the dural defect may be necessary to prevent further complications, such as superficial siderosis.

Study Limitations

1
Single case report limits generalizability.
2
Causation between trauma and dural defect is suspected but not definitively proven.
3
Long-term outcomes of surgical repair are not discussed.

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