I was wondering if you would be able to look at Zachary's other MRI's/Xrays to see if there is anything there that can help with the diagnosis of the immobility of his back?
I also wanted to be sure I understood that the findings from Z's Meylogram shows that the leak is in a place that can not be repaired and that SS is still the diagnosis for that.
I also wanted to find out if there is a way for my husband and I to see the pictures which show the adhesion of the lining of Z's spinal cord. We feel that the education and the viewing of these pictures will help us to better understand how and exactly where this is taking place in our son's body.
Thank you so ... much for all you do!
Michelle Huguley
Dear Mrs. Huguley,
I have spent hours looking at Zachary's spine MRI looking for other explanations for his spine stiffness. His vertebra (bones) look fine to me and to radiology. This is one reason that I am asking several specialists to review Zachary's case with me. I would like someone with spine and/or spinal rehabilation expertise to see him. I spoke to both Dr. Levy in Neurology and Dr. Sudhir Kathuria in neuroradiology/interventional radiology at Johns Hopkins. They feel that rather than an arachnoid cyst along his thoracic spine that he most likely has an old subdural fluid collection, perhaps this occured at the time of the MVA years ago. The subdural fluid can be seen on MRI and appears to be clear fluid, not blood but the way that fluid gets into the subdural space is usually tearing of very small veins in the subdural space at the time of trauma. Over time, the blood is removed by the body and clear fluid is left. This fluid collection stretches from about T2-T10. Arachnoid cysts and subdural fluid collections are very similar in appearance, but you are usually born with an arachnoid cyst and a subdural fluid collection may appear after trauma. There is not a way to "repair" or remove this fluid from along the spine according to several neurosurgeons and neuroradiologists and his spinal cord looks "healthy." Superficial siderosis is still the diagnosis. I can email you some slides that show the adhesion/fluid collection in the thoracic spinal cord (I will remove Zachary's name and medical record number as they will be sent via regular email). If they do not make sense, I can review them with you at our next appointment.
Radiology Report
- Large intradural filling defect along the dorsal aspect of the thoracic spinal cord.
- This is the most suggestive for an arachnoid cyst, a component of fibrosis however is not excludable.
- It is not possible to determine whether this filling defect is the cause or the result of the patient's extensive hemosiderosis.
Filling defect. Looks like a crescent instead of a ring. Extensive in t-spine
Many axial images show this crescent (filling defect)
Harder to see on sagittal images, but posteriorly, contrast does not move as well. Should be white contrast material on either side of the gray, tube-like spinal cord.
Zachary has been doing his PT here at home since before Christmas and it seems to be to keeping the pain to a minimum, however, today after school he came home in some pretty serious pain, it took two benadryl between the hours of 3:00 and 6:30, and his TENS on a much higher setting to get him even close to being able to join the boys at our church for Cub Scouts, he played some dodgeball and is paying the price for that now. :(
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