Hirayama disease: the importance of adequate flexion MRI for diagnosis
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We read with great interest the recent correspondence by Cortese et al. , who described the importance of an early diagnosis of Hirayama disease (HD) in a patient who underwent conservative therapy. Herein, we stress the critical role of adequate flexion during dynamic MRI in the diagnosis of HD based on our recent experience.
HD is a benign self-limiting disease that causes distal upper limb weakness and atrophy, which progresses over 2–4 years, followed by spontaneous arrest usually within 5 years. HD is thought to occur secondary to spinal cord compression by the posterior dural sac during neck flexion leading to ischemic damage to the anterior horns. The dynamic anterior shift of the dural sac is considered indicative of early progressive disease . Imaging findings on neutral position MRI that should alert the physician include loss of normal cervical spine lordosis, loss of attachment between the posterior dural sac and subjacent lamina, lower cervical cord...
KeywordsHirayama disease Flexion MRI Myelopathy Cervical
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