PMC8720476_01
Photograph of the patient showing muscle wasting of the right proximal upper limb predominantly arm and forearm as compared to the left upper limb.
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F1
A 17-year-old adolescent male presented with 3 months of gradually progressive right upper limb weakness (3/5) and atrophy (i.e., involving the muscles of arm and forearm muscles) [Figure 1].
(a) Sagittal T2W magnetic resonance imaging (MRI) in neutral position image demonstrating loss of normal lordotic curvature with focal kyphotic angulation of the cervical spine with increased signal intensity in the cervical spinal cord at C4-C5 intervertebral level. Degeneration of intervertebral disks noted at multiple levels. (b) Axial MRI T2W image demonstrating typical snake eye hyperintense signals of the cervical spinal cord at C4-C5 level suggestive of subacute spinal cord ischemia. (c) Enlarged (zoomed in) Axial MRI T2W image demonstrating typical "snake eye" hyperintensity in the anterior horn cells of the spinal cord, (d) Diagrammatic representation of atrophied and gliosed anterior horn cells demonstrating snake eye appearance.
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F2
The cervical MR showed cord compression, flattening, and atrophy with kyphosis from C2 to C6 maximum at C4-C5 apex [Figure 2a]. T2W scans demonstrated hyperintense signals in the anterior horn cell region at C4 (characteristic "snake eyes" sign) [Figure 2b-d]. The sagittal T2W MR imaging (MRI) in flexion demonstrated a posterior epidural soft-tissue mass with prominent flow voids from C3 to C6 compressing/displacing the cord anteriorly; this mass markedly enhanced with contrast [Figures 3-5].
Sagittal T2W magnetic resonance imaging in flexion position demonstrating prominent posterior epidural soft-tissue component (arrow) displacing the posterior dural sac anteriorly and causing compression of the spinal cord with increased signal intensity(myelomalacia/subacute infarct) at C4 and C5 vertebral levels. Note: the apex of compression at C4 and C5 levels in the spinal canal causing maximum cord compression due to the kyphotic curvature.
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F3
T2W scans demonstrated hyperintense signals in the anterior horn cell region at C4 (characteristic "snake eyes" sign) [Figure 2b-d]. The sagittal T2W MR imaging (MRI) in flexion demonstrated a posterior epidural soft-tissue mass with prominent flow voids from C3 to C6 compressing/displacing the cord anteriorly; this mass markedly enhanced with contrast [Figures 3-5].
Pre contrast T1W magnetic resonance (MR) sagittal (a) and axial image (b) in flexion position demonstrating prominent posterior epidural space displacing the posterior dural sac anteriorly and causing compression of the spinal cord. Post contrast T1W MR sagittal (c) and axial image (d) in flexion demonstrating homogeneous enhancement in the posterior epidural space at C3-C6 vertebral levels (Arrows).
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F4
T2W scans demonstrated hyperintense signals in the anterior horn cell region at C4 (characteristic "snake eyes" sign) [Figure 2b-d]. The sagittal T2W MR imaging (MRI) in flexion demonstrated a posterior epidural soft-tissue mass with prominent flow voids from C3 to C6 compressing/displacing the cord anteriorly; this mass markedly enhanced with contrast [Figures 3-5].
Post contrast TIW sagittal magnetic resonance imaging image (a) in flexion position demonstrating the characteristic crescent shaped posterior epidural enhancement at C3-C6 vertebral levels. (b) Represents graphical outline of crescent shaped enhancement.
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F5
T2W scans demonstrated hyperintense signals in the anterior horn cell region at C4 (characteristic "snake eyes" sign) [Figure 2b-d]. The sagittal T2W MR imaging (MRI) in flexion demonstrated a posterior epidural soft-tissue mass with prominent flow voids from C3 to C6 compressing/displacing the cord anteriorly; this mass markedly enhanced with contrast [Figures 3-5].