I received a call from Dr Pinto this morning. He explained that the preliminary report of my MRI had shown herniation of the spinal cord between the T2 and T3 vertebra.
15/04/2016 07:50:00
Result
Clinical History : 48 hospital IT manager. 5/12 worsening bilateral lower limb weakness left >right, hyperreflexic left leg, upgoing plantar, clonus. reduced sensation right leg to T8. Previous testicular ca. Brown-sequard ?spinal cord mass ?ca
EGFR on 05/02/2016 – TEST RESULT: >90 ml/min
CREATININE on 05/02/2016 – TEST RESULT: 54 umol/l
MRI Spine Whole : Sag T1/T2 STIR whole spine limited thoracic region axials.The most significant abnormality is at T2/3, where the thoracic cord is deviated anteriorly within the thecal sac. On some of the images it appears to herniate outwith the dural margin. There is no evidence of an arachnoid cyst posteriorly.
The findings are of a ventral cord hernia/ thoracic anterior spinal cord adherence syndrome (TASCAS)
There is minor cervical spondylosis with non compressive disc osteophytes at C4/5 and C5/6. No significant lumbar abnormality.
Normal appearances of the craniocervical junction, cord conus and cauda equina. No other adverse finding.
In the first instance repeat imaging with CISS is advised. Spinal Neurosurgical opinion is also suggested.
This would seem to be consistent with the pain I get between my shoulder blade and spine to varying degrees. I can’t remember when that started, but it may well have been around the same time – late 2012 to early 2013. It was certainly before we moved to Southampton in July 2013 as I remember discussing it with Dr Rosa at the Salisbury surgery and he suggested I get a sports massage. The good news (for now at least) is that there is no suggestion of the condition being linked to cancer. A mighty sigh of relief. It would appear I have what is deemed to be a rare condition, with only 30-40 people per million contracting the disorder. On reviewing my clinic notes there is a note that the impression given from my symptoms and tests was that I have Brown-Séquard syndrome. Dr Pinto described the cause as idiopathic spinal cord herniation. This itself is rare – as of a paper written in 2009, only 100 cases had been documented in English since it was discovered in 1974. Of these only 33 have been male. Dr Pinto doesn’t feel there is much he can offer at this stage as he has only seen a couple of instances in his 10+ years as a neurology consultant, and so is referring me straight to Mr Ali Nader-Sepahi, a neurosurgeon at SGH. I am also being referred for a more detailed MRI of the thoracic spine to try to identify what is causing the herniation.