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Figure 4: Transverse T2-weigheted MRI section through the C5-C6 area
revealed the herniated disk fragment to compress the left anterolateral spinal
cord. MRI: magnetic resonance imaging

Figure 6: Transverse T2-weigheted MRI section through the C5-C6 area
showing unchanged the herniated disk fragment compressing the left
anterolateral spinal cord (arrows). MRI: magnetic resonance imaging

is an unusual case since one would expect symptoms
primarily related to the nerve root compression in
addition to the spinal cord impingement. Furthermore,
even in anterolateral disk herniation, the spinal cord
was compressed, and corticospinal tract signs should
be expected besides the spinothalamic tract signs.

In conclusion, this represents a unique case in which
a herniated disk presses only the spinothalamic tracts,
and that needed to be differentiated from a temporarily
occurred asymptomatic radiation-induced effect, and
tumor recurrence. The patient was instructed to wear a
soft collar and avoid heavy use of her arms. The patient
also received medical treatment with nonsteroidal anti-
inflammatory drugs and gabapentin. Laminectomy was
not performed due to the significant clinical improvement
after the medical therapy, while the patient has improved
at the 6-month follow-up evaluation.
Figure 5: T1-weigheted MRI with contrast of the C-spine during the patient’s
visit to our clinic demonstrating disappearance of the C2 spinal cord lesion Financial support and sponsorship
but presence of the herniated disk at the C5-C6 level (arrow). MRI: magnetic
resonance imaging Nil.
ventricle and cause hydrocephalus, as in our case. Conflicts of interest
Gross-total resection followed by local radiotherapy There are no conflicts of interest.
could be curative if there is no CSF seeding. [3-5] During
tumor recurrence, local recurrence is the primary REFERENCES
pattern of failure and spinal seeding is uncommon
in the absence of local failure. In the present case, 1. Goussia AC, Kyritsis AP, Mitlianga P, Bruner JM. Genetic
[1]
abnormalities in oligodendroglial and ependymal tumours. J
a herniated C5-C6 disk compressed only the left Neurol 2001;248:1030-5.
anterolateral spinothalamic tracts but not the left 2. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger
C6 nerve root or the corticospinal tracts, resulted in PC, Jouvet A, Scheithauer BW, Kleihues P. The 2007 WHO
classification of tumours of the central nervous system. Acta
controlateral arm, body and leg sensory changes. This Neuropathol 2007;114:97-109.

Neuroimmunol Neuroinfammation | Volume 3 | March 14, 2016 67