A 69-year-old woman presented with insidiously progressive and disabling pain in the right leg. There was no history of trauma or surgery. An examination revealed features suggestive of thoracic level Brown-Sequard syndrome. MRI showed focal anterior deviation of the thoracic cord at T3/T4 level consistent with cord herniation (figures 1 and 2⇓).
Figure 1. Sagittal constructive interference in steady-state MRI reveals characteristic anterior deviation of the thoracic cord at T3/T4 level.
Figure 2. Axial T2*-weighted MRI exquisitely demonstrates the anterior displacement of the cord with dilation of the posterior CSF space. No cord signal abnormality is seen.
Transdural spinal cord herniation is rare and may be spontaneous, post-traumatic, or post-surgical in etiology. The most common site is the thoracic spine where there is spontaneous ventral herniation.1,2⇓ Clinical manifestations include Brown-Sequard syndrome (the most common), myelopathy, radiculopathy, or rarely isolated pyramidal signs. Typical imaging features on CT myelogram and MRI include a rotated or displaced cord with dilated CSF space in the opposite direction of the cord displacement. There may also be an associated arachnoid/pseudoarachnoid cyst.1,2⇓
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