An Unusual Case of Footdrop

Levene, Howard; Nimmagadda, Anitha; Levi, Allan D.

doi:10.1227/01.neu.0000363406.81956.a9

Cited by 16 publications

(8 citation statements)

References 9 publications

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“…For example, Emamian et al [ 6 ] reported one case in which a lumbar herniated disk mimicked a neurinoma in 1993. Subsequently, Sharma et al [ 4 ], Ashkenazi et al [ 8 ], and Levene et al [ 5 ] also demonstrated three cases of disc sequestration that mimicked a nerve sheath tumor. Generally, disc fragments that mimic tumors appear hypointense on T1-weighted images and hyperintense on T2-weighted images.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) is the first diagnostic tool and gold standard for evaluating spinal pathologies [ 2 ]. However, in rare cases, the appearance of disc sequestration upon MRI is similar to that of a common epidural tumor, such as neurinoma or meningioma [ 3 – 5 ]. In 1993, Emamian et al [ 6 ] detailed one case of lumbar herniated disk mimicking a neurinoma.…”

Section: Introductionmentioning

confidence: 99%

“…In 1993, Emamian et al [ 6 ] detailed one case of lumbar herniated disk mimicking a neurinoma. Since then, mimicking tumor discs have been reported in several case reports [ 1 – 5 , 7 – 22 ]. Open surgery was performed in all cases [ 1 – 22 ] since the surgeons were unable to make a definitive diagnosis using computed tomography (CT), MRI, and gadolinium-enhanced (Gd) MRI before operation.…”

Section: Introductionmentioning

confidence: 99%

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Two cases in which 3D MRI was used to differentiate between a disc mass that mimics a tumor and neurinoma

Jia

Wei

et al. 2018

BMC Musculoskelet Disord

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BackgroundSince disc sequestration that mimics a tumor is rare and sometimes presents with an atypical appearance upon magnetic resonance imaging (MRI), it is often confused with other more common epidural and intradural neoplasms, particularly neurinoma. Open surgery is necessary due to the difficult of achieving a definitive diagnosis using computed tomography, MRI, and gadolinium- enhanced MRI prior to operation. Herein, we describe the use of coronal MR images of 3D fast-field echo with water selective excitation in the diagnosis of disc sequestration mimicking a tumor.Case presentationTwo patients were admitted to our hospital with back pain, radiating pain, and hypoesthesia in the right lower limb. MRI revealed tumor-like masses in the lateral recess of L3 and posterior to the body of L4. The initial diagnosis indicated disc sequestration mimicking a tumor and neurinoma. The coronal MR images of 3D fast-field echo with water selective excitation showed a clear boundary between the tumor-like mass and the nerve root. Moreover, the mass was also completely separated from the dura. Therefore, neurinoma was excluded as a possible diagnosis prior to operation. Surgical excision to perform removal of the gross mass was performed in one patient. The histopathological diagnosis was consistent with the 3D fast-field echo with water-selective excitation MRI. Another patient was successfully treated by minimally invasive endoscopic surgery.ConclusionsDisc sequestration that mimics a tumor is difficult to diagnose preoperatively. As a non–invasive strategy, coronal MR images of 3D fast-field echo with water selective excitation is a helpful imaging tool for differentiating between diagnosis of disc sequestration that mimics a tumor and neurinoma prior to operation. If the disc fragment of mimicking tumor can be identified prior to operation, open surgery may not be necessary for all patients. Minimally invasive endoscopic surgery also is an alternative strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Two cases in which 3D MRI was used to differentiate between a disc mass that mimics a tumor and neurinoma

Jia

Wei

et al. 2018

BMC Musculoskelet Disord

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“…Migratory disc herniations can travel to various locations, including epidural, intradural, intraneural, lateral (intraforaminal or extraforaminal), or retroperitoneal spaces. [5][6][7][8][9][10][11] Because these fragments can separate from the parent defect, they can present as isolated distinct lesions and appear differently than typical disc herniations on imaging. These variations in imaging characteristics can make diagnosing far lateral disc herniations challenging.…”

Section: Discussionmentioning

confidence: 99%

Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases

Sun

Muftuoglu

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Migratory disc herniations can mimic neoplasms clinically and on imaging. Far lateral lumbar disc herniations usually compress the exiting nerve root and can be challenging to distinguish from a nerve sheath tumor due to the proximity of the nerve and characteristics on magnetic resonance imaging (MRI). These lesions can occasionally present in the upper lumbar spine region at the L1–2 and L2–3 levels. OBSERVATIONS The authors describe 2 extraforaminal lesions in the far lateral space at the L1–2 and L2–3 levels, respectively. On MRI, both lesions tracked along the corresponding exiting nerve roots with avid postcontrast rim enhancement and edema in the adjacent muscle tissue. Thus, they were initially concerning for peripheral nerve sheath tumors. One patient underwent fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) screening and demonstrated moderate FDG uptake on PET-CT scan. In both cases, intraoperative and postoperative pathology revealed fibrocartilage disc fragments. LESSONS Differential diagnosis for lumbar far lateral lesions that are peripherally enhancing on MRI should include migratory disc herniation, regardless of the level of the disc herniations. Accurate preoperative diagnosis can aid in decision making for management, surgical approach, and resection.

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“…In both patterns, the clinical manifestations of disc herniation and the morphologic similarity between DS and tumor coexist. The former has been reported much more frequently in the literature, as we found 31 reports of DS resembling tumoral lesions in the extradural, 6,8,10,[15][16][17][18][19][20][21][22][23][24][25][26][27] intradural, 19,[28][29][30][31][32] intramedullary, 33 foraminal, [34][35][36][37][38][39] and extraforaminal [40][41][42] sites. Almost all the cases were in lower lumbar region with few cases in cervical and thoracic spine.…”

Section: Discussionmentioning

confidence: 99%

Direct epidural metastasis of breast cancer mimicking a large lumbar disc sequestrum: A case report and review of literature

Mirzashahi

Razzaghof

Irani

2023

Clinical Case Reports

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An Unusual Case of Footdrop

Abstract: Using the term anterior disc herniation will aid clinicians in including herniated disc fragments in the differential diagnosis for lesions affecting nerve roots anterior to the spine in this retroperitoneal location.

Cited by 16 publications

References 9 publications

Two cases in which 3D MRI was used to differentiate between a disc mass that mimics a tumor and neurinoma

Two cases in which 3D MRI was used to differentiate between a disc mass that mimics a tumor and neurinoma

Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases

Direct epidural metastasis of breast cancer mimicking a large lumbar disc sequestrum: A case report and review of literature

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