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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(10): 760
DOI: 10.1590/0004-282X20170131
IMAGES IN NEUROLOGY

Spine magnetic resonance imaging with dynamic flexion sequences for evaluation of mini-polymyoclonus

Imagens de ressonância da coluna vertebral com sequências dinâmicas de flexão para avaliação de mini-polimioclonus
Ronnyson Susano Grativvol
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil;
,
Wagner Cid Palmeira Cavalcante
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil;
,
Vitor Marques Caldas
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil;
,
Gabriela Almeida Pimentel
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil;
,
Carlos Otto Heise
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil;
,
Leonardo Guilhermino Gutierrez
2   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brasil.
,
Leandro Tavares Lucato
2   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brasil.
,
Ricardo Nitrini
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brasil;
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An 18-year-old male presented with a two-year history of bilateral hand tremulousness. Neurological examination revealed weakness in both hands, but predominantly on the right. With arms outstretched, distal mini-polymyoclonus occurred[1]. The rest of the neurological examination was unremarkable. Motor and sensory nerve conduction studies were normal. Electromyography showed fibrillations and fasciculations at rest and signs of mild chronic reinnervation in C8-T1 muscles bilaterally. Spine MRI with dynamic flexion sequences[2] revealed cervical cord atrophy, forward shifting of the posterior wall of the cervical dural sac, and contrast-enhancement of an enlarged posterior epidural compartment ([Figure]). This constellation of features suggests Hirayama disease.

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Figure Neutral cervical spine MRI sagittal images (A and B). In A, a T1-weighted image shows C6-T1 cord atrophy (arrowheads) and in B a T2-weighted image demonstrates slight detachment of the posterior dura mater (arrow). Flexion cervical spine MRI sagittal images (C and D). In C, a T2-weighted image reveals forward displacement of the posterior wall of the dural sac with some impression over the cord (arrow). In D, a contrast-enhanced T1-weighted image shows engorgement of the posterior epidural venous plexus, with enhancement (arrow).


Publication History

Received: 09 January 2017

Accepted: 18 July 2017

Article published online:
04 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ong JJY, Wang FSJ, Chan YC. Teaching neuroimages: a case of Hirayama disease presenting with polymyoclonus. Neurology. 2015;85:e156-7. https://doi.org/10.1212/WNL.20170131201701312144
  • 2 Lehman VT, Luetmer PH, Sorenson EJ, Carter RE, Gupta V, Fletcher GP et al. Cervical spine MR imaging findings of patients with Hirayama disease in North America: a multisite study. AJNR Am J Neuroradiol. 2013;34(2):451-6. https://doi.org/10.3174/ajnr.A3277