Mystery case responses
© 2016 American Academy of Neurology. A 48-year-old man developed numbness in the left leg, which progressed gradually to paresis and urinary incontinence. Neurologic examination revealed a left Brown-Sequard syndrome with leg paresis, mild spasticity, reduced proprioception, and contralateral thermal and painful hypoesthesia below T6. MRI revealed a thoracic spinal cord herniation (SCH) (figure). Idiopathic SCH is relatively rare. Pathogenesis involves a dura mater defect (see video on the Neurology® Web site at Neurology.org); herniation develops over a progressive pressure gradient through the dural fissure.2Surgical reduction is typically performed if symptoms progress, but mild symptoms may be eligible for conservative treatment and monitoring. Surgical spinal reduction and dural repair usually reverses neurologic deficits.