Imaging in Hirayama disease.

Hirayama disease, also known as Sobue disease is a rare nonprogressive spinal muscular atrophy. Here, we report a case series of three young males presenting with atrophy of distal upper limb and Hirayama disease as their clinico-radiological diagnosis. Magnetic resonance imaging (MRI) revealed loss of cervical lordosis with focal areas of lower cervical cord atrophy in a neutral position. MRI in flexion position revealed, anterior displacement of the detached posterior dura from the underlying lamina compressing the thecal sac and widened posterior epidural space with flow voids seen better on 3D-CISS images. All the three patients were managed conservatively.

Susceptibility artifacts in ruptured intracranial dermoid cysts: a poorly understood but important phenomenon.

Rupture of intracranial dermoid cyst is a rare event. The classical imaging feature is described as a fat-containing lesion with tiny fat droplets in the subarachnoid or ventricular system. The lesion and the fat droplets show susceptibility blooming artifact on susceptibility-weighted images (SWI). Knowledge of this fact is important because these lesions mimic the blooming artifact of haemorrhage on SWI. The cause of the susceptibility artifact in intracranial dermoids has not been reported in the literature to date. We describe two cases of ruptured intracranial dermoids in the basifrontal region and review the clinical and imaging features and possible causes of susceptibility artifacts in intracranial dermoid cysts.

Fluorotic cervical compressive myelopathy, 20 years after laminectomy: A rare event.

BACKGROUND: Spinal cord compression in flourosis is a common complication. These complications are mainly due to compression of the spinal cord by thickening and ossification of posterior longitudinal ligament and ligamentum flavum. Surgical decompression is the treatment of choice for fluorotic spinal cord compression. The recurrence of spinal cord compression after surgical decompression in flourosis is a rare event. CASE DESCRIPTION: We are presenting a case of a 63-year-old man who belonged to Kanpur, an endemic fluorosis region in India, with symptoms of cervical cord compression cranial to the operative site, 20 years after laminectomy for cervical fluorotic myelopathy. Urinary and serum fluoride levels were elevated. The patient underwent a skeletal survey: computed tomography and magnetic resonance imaging of the cervical spine showed a postoperative defect of laminectomy, osteosclerosis, osteophyte formation, calcification of the intraosseus membrane in the forearm, thickening and ossification of the posterior longitudinal ligament at C1, thickening and ossification of the residual ligamentum flavum at C1/C2, and dural calcification at the C2 vertebral level and compressive myelopathy. The patient refused surgical decompression and was managed with tizanidine HCl (an antispasticity medicine), a sublingual single night dose, 8 mg for symptomatic relief. CONCLUSION: The recurrence of spinal cord compression in the fluorotic spine 20 years after laminectomy is a very unusual event and hence the patient should be kept under observation for a long duration. This case report contributes to the literature associated with the management of fluorotic spine.

Accessory parotid gland with ectopic fistulous duct--diagnosis by ultrasonography, digital fistulography, digital sialography and CT fistulography. A case report and review of current literature.

Accessory parotid glands are a common clinical occurrence and usually drain into the main Stenson's duct by small ductules and thereby, into the buccal cavity. Presence of an accessory parotid gland with an ectopic fistulous duct is a rare occurrence. We present the imaging findings in a case of right accessory parotid gland with ectopic fistulous duct associated with bilateral pre-aural appendages. Diagnostic workup was done by ultrasonography, sono-fistulography, contrast digital fistulography, contrast digital sialography and computed tomography fistulography. Imaging showed a right accessory parotid gland lying anterior to and separate from the main parotid gland draining via an ectopic fistulous duct opening over the right cheek. The child was managed surgically by internalisation of the duct to open into the buccal mucosa and excision of pre-aural appendages.