Atypical clinical presentation of idiophatic thoracic spinal cord herniation

Case report.

To report an adult female patient with idiopathic spinal cord herniation presenting with pain without symptoms of myelopathy.

Idiopathic spinal cord herniation is a rare but increasingly recognized cause of myelopathy that can be successfully diagnosed with the almost pathognomonic findings on magnetic resonance imaging. There are over 90 cases that were treated surgically reported in the literature.

A 38-year-old woman presented with a 6-month history of chest pain radiating through to the back in bilateral T4 dermatome. Her neurologic examination was normal. Magnetic resonance study revealing ventral displacement and adherence of spinal cord at T4 level led to the diagnosis of idiopathic spinal cord herniation. Mild spinal cord atrophy with the dilatation of dorsal subarachnoid space was determined.

The patient is observed-up on conservative treatment for pain.

Idiopathic spinal cord herniation is 1 of the causes of unexplained atypical thoracic pain with or without signs and symptoms of myelopathy. Magnetic resonance imaging is recommended to establish the diagnosis in patients, particularly age ranged from 36 to 59, whose clinical and laboratory findings are inconclusive.