24
Journal of
CLINICAL NEUROMUSCULAR DISEASE
Image
Volume 16, Number 1 September 2014
Spinal Magnetic Resonance Imaging in Chronic Poliomyelitis Matthias Georg Ziller, MD, FRCPC* and Elijah W. Stommel, MD, PhD†
FIGURE 1. Bilateral hyperintense signals outline the anterior horns of the spinal gray matter in the dorsolumbar spine: (A) T2 sagittal imaging and (B) T2 axial imaging.
Key Words: poliomyelitis
magnetic
resonance
imaging,
( J Clin Neuromusc Dis 2014;16:24)
CASE REPORT
From the *Department of Neurology, McGill University, St. Mary’s Hospital Centre, Montreal, QC, Canada; and †Department of Neurology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH. The authors report no conflicts of interest. Reprints: Matthias G. Ziller, MD, FRCPC, Assistant Professor, McGill University, St. Mary’s Hospital Centre, 3830, Lacombe Avenue, Montreal, QC, H3T 1MS, Canada (e-mail: matthias.ziller@ mcgill.ca). Copyright © 2014 by Lippincott Williams & Wilkins
A 61-year-old woman presented for evaluation of pain in both lower extremities and in the lower back. She had a history of poliomyelitis at the age of 8 years. Clinical examination showed normal strength in the upper extremities. Mild symmetric muscle atrophy was present in the distal lower extremities. Strength of ankle dorsiflexion and toe extension was decreased to 4/5. Upper-limb reflexes were hypoactive, and reflexes were absent in the lower limbs. Toes were downgoing. Sensory examination was normal. Motor nerve conduction studies showed decreased compound muscle action potential amplitudes and normal velocities. Sensory responses were normal. Electromyogram showed chronic neurogenic changes without active denervation.
Magnetic resonance imaging of the thoracic spine had been obtained at an outside facility and showed symmetric hyperintense T2 signals at the T10–T11 level and spanning over several segments (Fig. 1A, T2 sagittal imaging) and following the outline of the anterior horns of the spinal gray matter (Fig. 1B, T2 axial imaging) without additional edema or swelling of the cord. Similar findings were previously described in both cervical and lumbar regions in both chronic and acute presentations and are thought to be quite specific for poliomyelitis.1,2 A retrospective neuropathological study3 described loss or atrophy of spinal motor neurons and reactive gliosis that is likely to be equivalent of the striking imaging findings in our patient. REFERENCES 1. Haq A, Wasay M. Magnetic resonance imaging in poliomyelitis. Arch Neurol. 2006;63:778. 2. Rao DG, Bateman DE. Hyperintensities of the anterior horn cells on MRI due to poliomyelitis. J Neurol Neurosurg Psychiatry. 1997;63:720. 3. Pezeshkpour GH, Dalakas MC. Long-term changes in the spinal cords of patients with old poliomyelitis. Signs of continuous disease activity. Arch Neurol. 1988;45:505–508.
Journal of
CLINICAL NEUROMUSCULAR DISEASE
Image
Volume 16, Number 1 September 2014
Spinal Magnetic Resonance Imaging in Chronic Poliomyelitis Matthias Georg Ziller, MD, FRCPC* and Elijah W. Stommel, MD, PhD†
FIGURE 1. Bilateral hyperintense signals outline the anterior horns of the spinal gray matter in the dorsolumbar spine: (A) T2 sagittal imaging and (B) T2 axial imaging.
Key Words: poliomyelitis
magnetic
resonance
imaging,
( J Clin Neuromusc Dis 2014;16:24)
CASE REPORT
From the *Department of Neurology, McGill University, St. Mary’s Hospital Centre, Montreal, QC, Canada; and †Department of Neurology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH. The authors report no conflicts of interest. Reprints: Matthias G. Ziller, MD, FRCPC, Assistant Professor, McGill University, St. Mary’s Hospital Centre, 3830, Lacombe Avenue, Montreal, QC, H3T 1MS, Canada (e-mail: matthias.ziller@ mcgill.ca). Copyright © 2014 by Lippincott Williams & Wilkins
A 61-year-old woman presented for evaluation of pain in both lower extremities and in the lower back. She had a history of poliomyelitis at the age of 8 years. Clinical examination showed normal strength in the upper extremities. Mild symmetric muscle atrophy was present in the distal lower extremities. Strength of ankle dorsiflexion and toe extension was decreased to 4/5. Upper-limb reflexes were hypoactive, and reflexes were absent in the lower limbs. Toes were downgoing. Sensory examination was normal. Motor nerve conduction studies showed decreased compound muscle action potential amplitudes and normal velocities. Sensory responses were normal. Electromyogram showed chronic neurogenic changes without active denervation.
Magnetic resonance imaging of the thoracic spine had been obtained at an outside facility and showed symmetric hyperintense T2 signals at the T10–T11 level and spanning over several segments (Fig. 1A, T2 sagittal imaging) and following the outline of the anterior horns of the spinal gray matter (Fig. 1B, T2 axial imaging) without additional edema or swelling of the cord. Similar findings were previously described in both cervical and lumbar regions in both chronic and acute presentations and are thought to be quite specific for poliomyelitis.1,2 A retrospective neuropathological study3 described loss or atrophy of spinal motor neurons and reactive gliosis that is likely to be equivalent of the striking imaging findings in our patient. REFERENCES 1. Haq A, Wasay M. Magnetic resonance imaging in poliomyelitis. Arch Neurol. 2006;63:778. 2. Rao DG, Bateman DE. Hyperintensities of the anterior horn cells on MRI due to poliomyelitis. J Neurol Neurosurg Psychiatry. 1997;63:720. 3. Pezeshkpour GH, Dalakas MC. Long-term changes in the spinal cords of patients with old poliomyelitis. Signs of continuous disease activity. Arch Neurol. 1988;45:505–508.
