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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La herniaci&#243;n espont&#225;nea o idiop&#225;tica de la m&#233;dula espinal&#44; a trav&#233;s de un defecto dural&#44; es una entidad cl&#237;nica muy rara&#44; aunque su frecuencia ha sido quiz&#225;s infravalorada antes del advenimiento de los estudios de imagen modernos&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de un var&#243;n de 49 a&#241;os de edad con una mielopat&#237;a progresiva&#44; consistente con un s&#237;ndrome de Brown-S&#232;quard&#46; En el estudio de RM y mielo-TC se pudo apreciar un desplazamiento llamativo de la m&#233;dula&#44; anterior y lateral&#44; a nivel de D6-D7&#44; con aumento del espacio subaracnoideo posterior&#44; compatible con el diagn&#243;stico de hernia medular&#46; El enfermo fue intervenido a trav&#233;s de una laminectom&#237;a y la hernia medular fue recolocada en el espacio intradural&#44; siendo el defecto dural reparado con una plastia de duramadre lio&#241;lizada&#46; El paciente mejor&#243; de su defecto motor pero no del sensitivo&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Debe considerarse el diagn&#243;stico de hernia medular espont&#225;nea en enfermos de edad media con mielopat&#237;a progresiva&#44; en los que no se aprecian causas de compresi&#243;n medular&#44; y que muestran los hallazgos t&#237;picos en los estudios de imagen&#46; El tratamiento quir&#250;rgico consigue la mejor&#237;a cl&#237;nica en muchos casos o al menos la detenci&#243;n en la progresi&#243;n de la enfermedad&#46;</p>"
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        "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Spontaneous spinal cord herniation through a dural defect is an unusual condition&#46; This entity has been pro-bably underestimated before the introduction of MRI&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We report a case of a 49-year-old man with a progressive Brown-S&#232;quard syndrome&#46; MRI and CT myelogram showed a ventrally displaced spinal cord at level T6&#8211;T7 and expansion of the posterior subarach-noid space&#46; Through a laminectomy&#44; a spinal cord herniation was identifled and reduced&#46; The anterior dural defect was repaired with a patch of lyophilized dura&#46; The patient recovered muscle power but there was no improvement of the sensory disturbance&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The diagnosis of spontaneous spinal cord herniation must be considered when progressive myelopathy occurs in middle-aged patients&#44; without signs of spinal cord compression and typical radiological findings&#46; Surgical treatment may halt the progressive deficits and even yield improvement in many cases&#46;</p>"
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                          "autores" => array:4 [
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Vol. 15. Núm. 5.
Páginas 484-489 (enero 2004)
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Vol. 15. Núm. 5.
Páginas 484-489 (enero 2004)
Hernia medular espontánea
Spontaneous spinal cord herniation
Visitas
2747
J.J. Rivas
, A. de la Lama, P. González, A. Ramos, M. Zurdo, R. Alday
Servicio de Neurocirugía. Hospital 12 de Octubre. Madrid
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Resumen

La herniación espontánea o idiopática de la médula espinal, a través de un defecto dural, es una entidad clínica muy rara, aunque su frecuencia ha sido quizás infravalorada antes del advenimiento de los estudios de imagen modernos.

Presentamos el caso de un varón de 49 años de edad con una mielopatía progresiva, consistente con un síndrome de Brown-Sèquard. En el estudio de RM y mielo-TC se pudo apreciar un desplazamiento llamativo de la médula, anterior y lateral, a nivel de D6-D7, con aumento del espacio subaracnoideo posterior, compatible con el diagnóstico de hernia medular. El enfermo fue intervenido a través de una laminectomía y la hernia medular fue recolocada en el espacio intradural, siendo el defecto dural reparado con una plastia de duramadre lioñlizada. El paciente mejoró de su defecto motor pero no del sensitivo.

Debe considerarse el diagnóstico de hernia medular espontánea en enfermos de edad media con mielopatía progresiva, en los que no se aprecian causas de compresión medular, y que muestran los hallazgos típicos en los estudios de imagen. El tratamiento quirúrgico consigue la mejoría clínica en muchos casos o al menos la detención en la progresión de la enfermedad.

Palabras clave:
Hernia medular espontánea
Mielopatía
Síndrome de Brown-Sèquard
Defecto dural
Resonancia magnética
Summary

Spontaneous spinal cord herniation through a dural defect is an unusual condition. This entity has been pro-bably underestimated before the introduction of MRI.

We report a case of a 49-year-old man with a progressive Brown-Sèquard syndrome. MRI and CT myelogram showed a ventrally displaced spinal cord at level T6–T7 and expansion of the posterior subarach-noid space. Through a laminectomy, a spinal cord herniation was identifled and reduced. The anterior dural defect was repaired with a patch of lyophilized dura. The patient recovered muscle power but there was no improvement of the sensory disturbance.

The diagnosis of spontaneous spinal cord herniation must be considered when progressive myelopathy occurs in middle-aged patients, without signs of spinal cord compression and typical radiological findings. Surgical treatment may halt the progressive deficits and even yield improvement in many cases.

Key words:
Spontaneous spinal cord herniation
Myelopathy
Brown-Sèquard syndrome
Dural defect
Magnetic resonance imaging

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