PMC7090124_01
(A,B) Physical examination of the patient's upper limbs showed hypotrophy of the right tenar eminence, of the extensor muscles of the fingers bilaterally, of the common extensor muscles of the fingers, with thinning of the dorsal face of the forearm, more evident on the right. Furthermore, over time, a characteristic "claw posture" of hands has become evident, more on the left side than on the right, limiting daily activities.
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F1
The investigations highlighted: hypotrophy of the right tenar eminence, of the extensor muscles of the fingers bilaterally, of the common extensor muscles of the fingers, with thinning of the dorsal face of the forearm, more evident on the right (Figures 1A,B).
Cervical MRI of the neck in antero flexion, which does not show the hallmark of HD, i.e., the forward movement of the posterior wall of the inferior cervical dural sac (2015).
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F2
Vertebral column in hyperlordotic attitude, with fulcrum in C3-C4, where there are concomitant arthrosis of the posterior apophyseal; forward displacement of the spinal cord in the C1-C2 tract, which, in a neutral attitude of the neck in orthostatism, laps the posterior profile of the district ligamentous-meningeal component (2017).
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F3
In 2017, a further neurological examination and a MRI of the cervical spine were performed (Figure 3).
(A,B) RM of the cervical spine, performed in supine position, showed a spinal canal of normal morphology and amplitude, with a regular caliber in all its diameters and without intrinsic alterations in signal intensity. It was also found regular adherence of dural sac to the posterior surface of the vertebral arches. In anteroflexion of the neck, straightening of the cervical segment is observed without, however, signs of detachment of the dural sac from the internal surface of the vertebral arch (2018).
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F4
The RM of the cervical spine performed at the end of September 2018 in supine position showed a spinal canal of normal morphology and amplitude (Figures 4A,B). The adherence of the dural sac to the posterior surface of the vertebral arches was also found to be regular.