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Hirayama disease. A 22-year-old male with upper extremity weakness and muscle atrophy. a There is focal T2 hyperintensity in the anterior horns (arrowheads). Subtle asymmetric focal cord atrophy at this level (C5–C6), slightly more conspicuous on the left (arrow). b Flexion view shows anterior displacement of the dura (arrows) with narrowing of the thecal sac (bracket), extending from C3 to T2, most pronounced at C5–C6. Note the long segment T2 hyperintensity within the anterior horns
