Hirayama's Disease

Findings:

The cervical spine is straightened on the sagittal T2 image. The cervical discs are desiccated. Asymmetric volume loss and T2 hyperintensity involves the left ventral and lateral aspects of the spinal cord extending from C5 through C7. Left central disc protrusions at these levels cause mild ventral cord indentation.

Differential Diagnosis/Discussion:

The presence of cervical cord signal abnormality with volume loss indicates a remote insult, with differential diagnosis including chronic multiple sclerosis, previous cord infarct, chronic neuromyelitis optica, and posttraumatic or post compressive myelomalacia. When associated with initially noncompressive appearing degenerative disc disease and a straightened cervical spine, chronic ventral compressive myelopathy as seen with Hirayama's disease could be considered.

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