An 82-year-old man presented with a 10-day history of progressive bilateral lower limb weakness and generalized numbness in his thorax and lower limbs. He reported a 3-week history of worsening gait ataxia, on a background history of 5 years of mild gait disturbance. On admission, the patient denied having problems with defecation, but had acute difficulty with micturition which resulted in catheter insertion. There was no history of spinal surgery, trauma, or spinal disorders. His medical history included ischemic heart disease, stroke, prostate cancer, and Paget's disease. Clinical examination was significant for a T4 sensory level, with reduced sensation to pin prick and light touch. Motor assessment revealed reduced power in bilateral lower limbs, with the following MRC grades: 1+/5 proximal and 3/5 distal. MRI was diagnostic for ISCH. T2-weighted images demonstrated ventral displacement of the thoracic spinal cord with moderate flattening, focal atrophy, and anterior herniation through the dura at T3-5 []. The CSF flow pattern dorsal to the cord at that level was preserved, but ventral to the cord, the CSF flow pattern was absent. Following a full discussion of the options with the patient, the decision was made for non-operative management. At 3 months after presentation, the patient remained neurologically stable.
This 58-year-old female complained about temperature changes and hyperpathy in her left leg for the past 12 months. On the right side, the sensibility was different but not normal. The strength in her left leg was diminished. These complaints ascended over time, initially starting at the foot and developing further to the groin at the time of presentation.\nNeurological examination revealed only a paretic quadriceps femoris muscle on the left side. Vital sensibility was disturbed on the left side below T10. The plantar reflexes on both sides were indifferent.\nAn MRI revealed a herniation of the SC at T8 (Figure ).\nDuring surgery, a laminectomy on T8 and T7 was performed. The dentate ligaments were transected. While gently mobilizing the SC from the left to the right, a large defect in the ventral dura was observed. The same maneuver at the right side revealed a fixed SC with the defect. After transection of some adhesions, a tumor-like extension of the SC was seen (Figure ) and was finally mobilized completely intradurally. To prevent re-herniation, an artificial graft was gently placed in front of the SC covering the defect and fixated laterally to the dural sleeve. Throughout the entire surgery, MEPs, SSEPs, and D-waves were monitored. Changes were not noticed. Post-operatively, the patient did not notice any new complaints.