Abstract
A man with 25 years of mild left neck, arm, and leg paresthesias had initial MRI in 1996 identifying a left C3-4 dorsal horn cavernous hemangioma. In 1997, hemorrhage (C3-7) and resection induced left arm > leg proprioceptive loss and clumsiness. Three months after surgical resection, left upper-body pain recurred; 2 years later, disabling colocalizing itch recurred.1 In 2012, ultra-high-resolution 7T MRI (figure) localized hemosiderin to specific dorsal horn laminae and detected rostral (C1-3) hypersignal invisible on conventional MRIs, most likely representing wallerian degeneration.2 These new imaging findings demonstrate the benefit of high-field spinal cord MRI and generate the hypothesis that his late-onset central itch might be related to delayed white matter degeneration.
A man with 25 years of mild left neck, arm, and leg paresthesias had initial MRI in 1996 identifying a left C3-4 dorsal horn cavernous hemangioma. In 1997, hemorrhage (C3-7) and resection induced left arm > leg proprioceptive loss and clumsiness. Three months after surgical resection, left upper-body pain recurred; 2 years later, disabling colocalizing itch recurred.1 In 2012, ultra-high-resolution 7T MRI (figure) localized hemosiderin to specific dorsal horn laminae and detected rostral (C1-3) hypersignal invisible on conventional MRIs, most likely representing wallerian degeneration.2 These new imaging findings demonstrate the benefit of high-field spinal cord MRI and generate the hypothesis that his late-onset central itch might be related to delayed white matter degeneration.
Figure. 7T MRI.
7T MRI with custom-made 19-channel coil (W. Zhao et al., Proceedings of the International Society for Magnetic Resonance in Medicine, 2012;310). Dual-echo T2*-weighted FLASH, repetition time = 514 milliseconds, 534 × 480 matrix, 0.37 × 0.37 × 3 mm3, R = 2 acceleration, 4:24 minutes acquisition. At-level hyposignal (filled arrow) indicates hemosiderin whereas above-level hypersignal (empty arrows) suggests dorsal-column wallerian degeneration. Ultra-high resolution enables exquisite details of spinal cord anatomy including visualization of individual ventral/dorsal nerve roots.
Footnotes
Author contributions: Dr. Cohen-Adad: study concept and design, acquisition of data. Dr. Zhao: acquisition of data. Dr. Wald: study supervision. Dr. Oaklander: study concept and design.
Study funding: NIH-P41RR14075, NIH-K24NS59892, NIH-P41RR14075, NMSS-FG1892A1/1.
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
References
- 1.Dey DD, Landrum O, Oaklander AL. Central neuropathic itch from spinal-cord cavernous hemangioma: a human case, a possible animal model, and hypotheses about pathogenesis. Pain 2005;113:233–237 [DOI] [PubMed] [Google Scholar]
- 2.Becerra JL, Puckett WR, Hiester ED, et al. MR-pathologic comparisons of wallerian degeneration in spinal cord injury. AJNR Am J Neuroradiol 1995;16:125–133 [PMC free article] [PubMed] [Google Scholar]