0:01

This is a patient who presented

0:03

with myelopathic symptoms.

0:05

On the T2-weighted and post-gad T1-weighted scans,

0:09

we see the marked scalloping of the vertebral bodies

0:14

greater than 50% of the vertebral body anterior

0:17

posterior diameter. And this is evident at L1, L2,

0:21

L3, and L4.

0:22

What's pretty dramatic about this

0:24

case is that even posteriorly,

0:26

you do see some element of the dural ectasia.

0:30

When we look on the coronal scan,

0:32

we see the expansion of the CSF space to the

0:36

right side more so than to the left side,

0:38

and going through what appear

0:39

to be the neural foramina.

0:41

And that is verified on the parasagittal scans where you

0:46

see the nerve roots expanding out through the CSF.

0:50

Now, these type of dural ectasias could be a source of

0:55

intracranial hypotension. That is low pressure within the

1:00

spinal canal, secondary to these dural ectasias. durorectasias.

1:05

Intracranial hypotension is manifested clinically

1:07

by headaches that are postural.

1:10

In other words, as soon as the patient sits up,

1:13

they get severe headaches.

1:15

These may also be secondary to CSF leakage,

1:19

as far as the etiology for intracranial hypotension.

1:23

Just want to point out that you note that there is no

1:25

evidence of contrast enhancement on

1:27

the T1 post-contrast scan.

1:29

So there are no tumors or cystic

1:31

neoplasms that are present,

1:33

which you would require to do the post-gadolinium

1:37

enhanced scan to rule out.

1:38

So an example of extreme dural ectasia.

1:42

In this case, it was isolated without a known syndrome.