0:01

I wanted to demonstrate this most

0:03

dramatic case that I have seen,

0:06

that is in the differential diagnosis

0:08

of an arachnoid cyst.

0:10

We have the post myelogram CT on either side of

0:14

the T2-weighted scan of the spinal cord.

0:18

On this T2-weighted scan,

0:20

you see that the cord is deviated dramatically anteriorly.

0:23

In fact, the cord is leading to scalloping

0:28

of the mid thoracic vertebrae,

0:31

and there is dilatation of the subarachnoid

0:33

space posteriorly.

0:34

This is another example of probably the most

0:37

dramatic case of transdural herniation of

0:40

the spinal cord that I've seen.

0:41

Here on the sagittal reconstructions

0:44

of the post myelogram CT,

0:47

we have the spinal cord coming up

0:49

here from the lumbar region.

0:51

And then you have the spinal cord being

0:53

deviated and causing scalloping of vertebrae.

0:57

And you have the subarachnoid space

1:00

dilatation, so this cord has herniated through

1:03

the dura, transdural spinal cord herniation

1:07

and subarachnoid space

1:09

dilatation. In this example, was secondary to trauma.

1:14

This is a very unusual complication and

1:17

oftentimes, the trauma is subclinical.

1:19

In other words,

1:19

the patient has had a remote history

1:21

of a motor vehicle collision.

1:23

And we find the patient with a thoracic myelopathy

1:26

months to years later demonstrating this phenomenon.

1:30

So again,

1:31

transdural herniation of the spinal cord.

1:33

The most dramatic example that I've seen.