with Drop Attack and
Chronic Neck and Arm Pain
A 40-year old lady had been suffering for years from neck
pain. A prior recumbent MRI had shown a C 5-6 disc degeneration
with a posterior bulge and a moderate segmental kyphosis.
Despite repeated attempts with conservative
treatment, the patient's symptoms worsened and were marked
by the onset of transient paresthesias, transit loss of muscle
tone in the legs and drop attacks.
When the Upright™ MRI was performed,
it showed both an increased disc protrusion and segmental
kyphosis at C5-6 relative to the recumbent MRI (thick arrow),
as well as, a descent of the cerebellar tonsils behind the
arch of C1 (thin arrow) accompanied by brainstem compression
(double arrow) against the odontoid process. This Chiara I
Malformation, with position-related downward herniation through
the foramen magnum visible only by means of the FONAR Upright™
MRI, explained the drop attacks and the transient loss of
tone in the legs, which could not be accounted for by only
the C 5-6 bulge seen on the recumbent MRI.
With the achievement of the correct
diagnosis of the patient's symptoms, made possible by the
FONAR Upright™ MRI, the correct surgical treatment was
accomplished and consisted of a posterior fossa decompression
plus a C1 laminectomy and dural plasty. The C 5-6 herniation
and kyphosis that was aggravated by the upright position was
treated with an anterior C 5-6 discectomy and a cage placement.
J.P. Elsig, M.D.
Fellow of the Swiss Orthopedic Society
Member of the Board of the Swiss Spine Society