CASE 17006 Published on 27.10.2020

Dural ectasia in neurofibromatosis type I

Section

Neuroradiology

Case Type

Clinical Cases

Authors

Uğur Kesimal

Radiology Department, Recep Tayyip Erdoğan University Education and Research Hospital

Islampasa Mahallesi, Sehitler Caddesi No.74, Rize, TURKEY

Patient

12 years, female

Categories
Area of Interest Neuroradiology spine ; Imaging Technique Conventional radiography, CT, MR
Clinical History

A 12-year-old female patient is brought to the emergency room due to a fall. She is referred for further evaluation due to some findings in his clinical examination in the emergency and orthopedic evaluation.

Imaging Findings

Figure 1. Scalloping is seen in lower lumbar vertebrae on lateral lumbosacral radiography.

Figure 2. In the sagittal T2 MRI images, the enlarged dural sac (dural ectasia) and concavity in the posterior parts of the lumbar vertebra is visible.

Figure 3. CT shows bony structure changes, similar to MRI.

Discussion

Background One of the reasons for dural sac widening is dural ectasia and it can be associated with Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, neurofibromatosis type 1, ankylosing spondylitis, osteogenesis imperfecta, acromegaly, trauma, surgery, tumors, and scoliosis. In Marfan syndrome, dural ectasia can observe 60-90% of patients [1]. In neurofibromatosis type 1, plexiform neurofibromas are thought to cause local infiltration of the dura that leading to the widening of the dura [2].

Clinical Perspective Many of the patients are asymptomatic. The most common symptoms are low back pain, headaches, and radicular pain in the involved limb and sometimes there can be urinary incontinence [1]. We should be aware of the radiological findings of dural ectasia in patients who underwent imaging for such complaints, and we should inform the requesting physician for further investigations on the etiologies that mentioned above.

Imaging Perspective Widening of the anteroposterior diameter of the dural sac and vertebral scalloping usually in the lumbar region can be observed in each of the MRI, CT, and radiographic examinations. But every part of the spinal canal can be affected. Spine MRI is the best imaging modality to evaluate the bony structures and spinal canal [3].

Outcome Most of the dural ectasia can be treated conservatively and do not require surgery.

Take Home Message We should be aware of this structural disorder which has typical radiological findings and guide clinicians in investigating etiologies.

Written informed patient consent for publication has been obtained.

Differential Diagnosis List
Dural ectasia
Tarlov cyst
Meningocele
Final Diagnosis
Dural ectasia
Case information
URL: https://www.eurorad.org/case/17006
DOI: 10.35100/eurorad/case.17006
ISSN: 1563-4086
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