Characteristic magnetic resonance imaging findings in. Mma is reported most frequently in asia but has a global distribution. Hirayama disease is a benign, nonprogressive motor neuron disease. Hirayama disease was diagnosed based on the history, muscle involvement, nerve conduction studies and mri findings. Methods and results here, we report a young female patient who developed the first signs. A retrospective analysis of preoperative magnetic resonance imaging features of the cervical spine. Contrast mri may be done to demonstrate findings better but is not essential. Original research article, magnetic resonance, report by journal of evolution of medical and dental sciences. It is typically marked by insidious onset of muscular atrophy of an upper limb, which plateaus after two to five years from which it neither improves nor worsens. Hirayama disease occurs mainly in young males between the ages of 15 and 25 years. Imaging features in hirayama disease sonwalkar ha, shah rs. Hirayama disease is a benign focal amyotrophy of the distal upper limbs involving c7, c8, and t1 segmental myotomes with sparing of the brachioradialis and proximal muscles of the upper limb innervated by c56 myotomes. Hirayama disease, also known as monomelic amyotrophy mma, is a rare cervical myelopathy that manifests itself as a selflimited, asymmetrical, slowly progressive atrophic weakness of the forearms and hands predominantly in young males. The dynamic flexion mri findings confirmed the clinical diagnosis of hirayama disease.
Hirayama disease hd is a rare motor neuron disorder that involves a single upper extremity. We report a case of an 18yearmale painter, who presented with gradually progressive, symmetrical bilateral weakness. Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Hirayama s disease affects mainly younger males who are between the ages of fifteen and twentyfive years of age, mostly in the nations of india and japan. It is usually sporadic, it has an insidious onset and there is a slow progression followed by stabilization in 24 years. It is an ideal resource for all radiologists, neuroradiologists, head and neck radiologists, and residents in these specialties. The symptoms of hirayama s disease as a whole, like the muscular atrophy associated with the disease, progress for a period of time, reaching a plateau, and then remain stable for many years after that point. It is clinically characterized by weakness and atrophy of the muscles of the hand and forearm. Nonprogressive juvenile spinal muscular atrophy of the. Factors affecting the surgical outcomes of hirayama disease.
The clinical features include insidious onset, predominantly unilateral upper extremity weakness and atrophy, cold paresis, and no sensory or pyramidal tract involvement. It is thought to be due to disproportionate growth between canal contents and bony spinal canal resulting in a lax dura in extension and vice versa. Hirayama disease monomelic amyotrophy clinically confused. We report clinical and magnetic resonance imaging findings in nine patients with hirayamas disease. Jul 05, 2017 the symptoms of hirayama s disease as a whole, like the muscular atrophy associated with the disease, progress for a period of time, reaching a plateau, and then remain stable for many years after that point. The present book will try to explain the physical principle behind each of these imaging modalities, together with a description of how these are implemented. We report the mr findings in two cases of hirayama disease, a kind of cervical myelopathy related to flexion movements of the neck. Patients and methods using mri, we examined 31 patients genetically diagnosed as having mjd, 20 patients with sporadic olivopontocerebellar atrophy, and 26 control subjects. A high index of suspicion is required when imaging the spine in neutral position and can be confirmed with dynamic mri in neck flexion and use of new sequences like t2space which should be an essential part of mri protocol. An initial study on normal subjects compared to patients with hirayama disease european journal of radiology, vol.
Clinical presentation and flexion mr imaging findings led to the diagnosis of hirayama disease. Flexion myelopathy is one of the suggested mechanism for hirayama disease hd but simultaneous radiological and neurophysiological evaluation is lacking. Objective to clarify the characteristic magnetic resonance imaging mri findings in patients with machadojoseph disease mjd diagnosed by genetic analysis. Hirayama disease, also known as sobue disease is a rare nonprogressive spinal. The forward displacement of the posterior dura of the lower cervical dural canal during neck flexion has been postulated to lead to lower cervical cord. Hirayama s disease hd, is a benign, selflimited, motor neuron disease, characterized by asymmetric weakness and atrophy of one or both distal upper extremities. Includes only the essential information so you get all you need to perform quality musculoskeletal mri without having to wade through too many details. Mri in flexion shows anterior displacement of the spinal cord and dural sac arrow.
Introduction hirayama disease hd, also known as monomelic amyotrophy mma was first reported by hirayama et al. Mar 01, 2004 forward shifting of posterior dural sac during flexion cervical magnetic resonance imaging in hirayama disease. Standardizing magnetic resonance imaging protocols, requisitions, and reports in multiple sclerosis. Monomelic amyotrophy, is a rare motor neuron disease first described in 1959 in japan. The diagnosis can be confirmed with imaging studies and laboratory tests. Chronic microcirculatory changes in the territory of the anterior spinal artery induced by repeated or sustained flexion account for the necrosis of the anterior horns of the lower cervical cord, which is the hallmark on pathology.
It is typically marked by insidious onset of muscular atrophy of an upper limb, which plateaus after. It is true that it is a rare condition, but cases of young adults not only japanese, are diagnosed in asia, europe and north xxxxxxx as well. It was identified for the first time in 1959 by hirayama et al. In my opinion, your sons condition fits better into hirayama than in als disease. Neck collar was advised to prevent neck flexion and to prevent further progression of disease and disease symptoms with follow up mri. The importance of flexion mri in hirayama disease with. Hirayama disease juvenile muscular atrophy of distal upper extremity is a cervical myelopathy predominantly affecting adolescent males. An update for radiologist based on 2017 magnetic resonance imaging in multiple sclerosis and 2018 consortium of multiple sclerosis centers consensus guidelines. Nov 03, 2015 hirayama disease is the most likely condition. The objective of the present study was to study the utility of mr imaging in young patients presenting with weakness and wasting of the distal upper. Methods and results here, we report a young female patient who. In flexion mr studies, we can see the striking and pathognomonic picture of anterior.
Its symptoms usually appear about two years after adolescent growth spurt and is significantly more common in males. Depicts both normal and abnormal anatomy, as well as disease progression, through more than 600 detailed images. Clinical dilemma solved by imaging shalabh jain, 1 siddharth yadav, 2 swarna gupta, 1 and ritu gupta 3 1 d e p a r t m e n to fr a d i o d i a g n o s i s,v m m ca n ds. Neurologic examination revealed atrophic changes in thenar, hypothenar muscles, interossei of. Aug 06, 2011 hirayama disease occurs mainly in young males between the ages of 15 and 25 years.
Feb 08, 2018 monomelic amyotrophy mma is a rare disease that causes muscle weakness in the upper extremities. Mri protocols, mri planning, mri techniques and anatomy. Pdf the objective of the study was to study the magnetic resonance imaging mri features of hirayama disease on a 3 tesla mri scanner. The flexion mri imaging protocol of cervical spine consisted for all patients in. It is primarily seen in young males of indian or asian descent. The objective of the study was to study the magnetic resonance imaging mri features of hirayama disease on a 3 tesla mri scanner. Hirayamas disease is a benign juvenile form of focal amyotrophy affecting the upper limbs. Mri findings in hirayama disease pubmed central pmc. Mr diagnosis chijen chen, chiungmei chen, chialun wu, longsun ro, sientsong chen, and tsonghai lee summary. Hirayama disease with proximal involvement hirayama disease is a slowly progressing benign motor neuron disease that affects the distal upper limb. To investigate the sensitivity and specificity of various neutralposition magnetic resonance mr imaging findings in the diagnosis of hirayama flexion myelopathy.
Characteristic magnetic resonance imaging findings in machado. Nine patients with clinically suspected hirayama disease were evaluated with neutral position, flexion, contrastenhanced mri and fast imaging employing steadystate acquisition fiesta sequences. Medical imaging is a collection of technologies, all having the purpose of visualization of the interior of the intact, living human body for the purpose of diagnosis. Hirayama disease, also termed nonprogressive juvenile spinal muscular atrophy of the distal upper limbs, is a kind of cervical myelopathy related to flexion movements of the neck 16. Neurologic examination revealed atrophic changes in thenar, hypothenar muscles, interossei of the hands, muscles of forearm more on right side. This book is an essential reference for a multidisciplinary approach to assessing diseases affecting the temporal bone. Hirayamas disease hd, also known as monomelicamyotrophy of distal upper limb, is characterized by pure distal motor atrophy of the upper limbs, affecting young men, in the muscles that are innervated by c7, c8 and t1 segments 14. This site provides clear and easily accessible guide to many of the practical aspects of mri including mri protocols, mri planning, mri anatomy, mri techniques, mri safety and much more. Contents upper extremity page shoulder elbow wrist finger thumb lower extremity hip pelvis thigh knee lower extremityshin ankle foot special cases soft tissue mass metal protocol.
Factors affecting the surgical outcomes of hirayama. Radiology ordering guide this guide is to help you order the correct imaging study. Hereditary neuralgic amyotrophy hna is a rare genetic disorder characterized by recurrent episodes of severe pain in the shoulder and arm. Hirayama disease hd, also known as monomelic amyotrophy ma, is a rare motor neuron disorder that affects one upper extremity 1. With increasing dispersion of these populations this condition is increasingly being encountered internationally. Nov 14, 2012 flow void noted in this posterior epidural space appears to be the engorged venous plexus due to dural shifting. Choose modality o ct o fluoroscopy o mri o ultrasound o mg decision tree 2. Objectives hirayama disease is a rare myelopathy, occurring predominantly in males with onset in the teens. Browns protocol i first became aware of doctor browns protocol in 1989 when i saw him on 2020 on abc. Hirayama disease is a form of muscular dystrophy seen in 2nd3rd decade. Muscular weakness and wasting of hand and forearm oblique amyotrophy.
There is no pain or sensory loss associated with mma. Mri protocols link to planit schedule scan room vs disease precautions link to wound vac and chest tube information link to lowering sar and b1rms tips contrast reaction, who to call contrast dosage quick reference guide. Sagittal t2weighted tse a, axial t2weighted ge b sequences in flexion. The forward displacement of the posterior dura of the lower cervical dural canal during neck flexion has been postulated to lead to lower. After numerous investigations, a dynamic cervical mri diagnosed her with hd with classic findings and she underwent an acdf at c6c7 without complications. Hirayamas disease hd, is a benign, selflimited, motor neuron disease, characterized by asymmetric weakness and atrophy of one or both distal upper extremities. Lower motor neurons are cells that help communicate information from the brain to the muscles that are involved in movement skeletal muscles.
Hirayama disease, also termed nonprogressive juvenile spinal muscular atrophy of the distal upper limbs, is a type of cervical myelopathy related to flexion movements of the neck. Cervical spine mri was performed before surgery with patients in the cervical neutral position and flexion position. Mri the imaging modality of choice with scan being done in both neutral and. Although mri is used most frequently in the diagnosis of neurologic disorders, it also has significant application to other body systems. Hirayama s disease hd is the eponym which continues to be used to identify a rare condition frequently reported in asia, most in japan and india, and rarely referred among westerners. A 29yearold man visited the hospital with a 1year history of weakened left proximal upper limb. Two have stabilised spontaneously over the course of many years, and mri scans show that typical changes have disappeared. Hirayama disease mri an 18 yo male with 4 year history of slowly progressive weakness of forearms and hand marked on right side. Role of dynamic mri study in hirayama disease parihar a. Health, general high definition television highdefinition television magnetic resonance. Hirayama disease monomelic amyotrophy clinically confused for carpal tunnel syndrome halil ay neurology department of medical faculty, harran university, sanliurfa, turkey abstract.
Hirayama s disease, also referred to as monomelic amyotrophy, mms, sobue disease, or juvenile nonprogressive amyotrophy, is an untreatable, focal, lower motor neuron disease. Dynamic flexion mri showed the cervical cord to be displaced anteriorly and compressed over the posterior surface of the c 56 vertebral bodies with a prominent crescent shaped epidural mass with flow voids c. Practical small animal mri is the seminal reference for clinicians using magnetic resonance imaging in the diagnosis and treatment of veterinary patients. Pure motor focal amyotrophy in distribution of c7,8,t1 spinal segments sporadic, men, second and early third decade. The purpose of this study is to determine the longterm progression and outcomes in patients who have the diagnosis of hirayama disease. It is characterized by progressive muscular weakness and atrophy of unilateral or asymmetrically bilateral distal upper limbs. Hirayamas disease quantitative imaging in medicine and surgery. Optimised mri in suspected hirayama disease is important as many of the described characteristic features such as anterior shift of the dura, loss of dural attachment, epidural space enlargement, flow voids and enhancement are often absent in routine supine cervical spine mri. Two brothers with classical flexion induced dynamic changes of the cervical dural sac nalini atchayaram 1, mk vasudev 2, gaurav goel 2. Dynamic post contrast mri evaluation of cervicothoracic spine is a helpful method in arriving at the correct diagnosis of hirayama disease and should be an essential part of the protocol in cases with high suspicion of motor neuron disease.
He was diagnosed with hirayama disease 9 years ago, while there. Monomelic amyotrophy mma, is a rare motor neuron disease first described in 1959 in japan. Mr imaging findings reported in patients from southeast asia and japan include loa of the dura to the lamina, asymmetric lower cervical spinal cord atrophy, spinal cord t2 hyperintensity, loss of cervical lordosis in the neutral position, and forward displacement of the dura with flexion mr imaging. However, utility of dti in evaluating the integrity of the spinal. Nov 06, 2014 what if everything you learned about cholesterol was a lie. Hirayama disease is an initially progressive disease caused by cervical neck flexion compressing the anterior horns of the lower cervical spinal cord. Mri of the newborn, part 2, an issue of magnetic resonance imaging clinics, 1e mri of the newborn, part i, an issue of magnetic resonance imaging clinics, 1e fetal therapy. Monomelic amyotrophy mma is suspected when a doctor observes signs and symptoms of the disease such as muscle weakness in one arm only that begins during adolescence or early adulthood. Cervical spine mr imaging findings of patients with.
Effect of neck flexion on f wave, somatosensory evoked. Hirayama disease, motor neuron disease, electromyography, late onset. Its symptoms usually appear about two years after adolescent growth spurt and is significantly more common in males average age of onset, 15 to 25yearold. Eight hd patients and seven matched controls were subjected to.
Diagnosis is based on clinical findings and dynamic flexion mri showing segmental spinal muscular atrophy, detachment of the posterior dura mater and venous. We report a case of an 18yearmale painter, who presented with gradually progressive, symmetrical bilateral weakness of hands and. Hirayama is a rare disease of the young where early diagnosis and treatment prevents the progression of disease. This study therefore evaluates the effect of neck flexion in hd using somatosensory evoked potentials seps, f waves, and magnetic resonance imaging mri. Imaging studies that may help confirm a diagnosis of mma include mri or ct. Scientific basis and critical appraisal of clinical benefits. Hirayama disease, also known as juvenile muscular atrophy of distal upper extremity, is a benign, uncommon disease predominantly seen in young men of southeast asian descent1 it often presents with insidious onset of muscular atrophy of the hands and forearms, and generally spares the brachioradialis1. Free radiology books download ebooks online textbooks.
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