Flexion MRI in a case of Hirayama disease

Brachioradialis Involvement in Hirayama's Disease: An Atypical Presentation of a Rare Cervical Myelopathy

Juvenile monomelic amyotrophy (JMA), also known as Hirayama's disease, is a rare cervical myelopathy that predominantly affects young Asian males. It is characterized by degeneration of anterior horn cells due to compression by the redundant dural sac. This study presents an atypical case of a 23-year-old Indian male who exhibited uncommon symptoms of JMA. The patient displayed progressive weakness and atrophy in the left forearm, including the usually spared brachioradialis muscle. Electrophysiological tests and MRI scans solidified the diagnosis of Hirayama's disease. After wearing a cervical collar for one year, the patient's condition stabilized, reinforcing the diagnosis. Unlike most JMA cases, this instance highlights the involvement of the brachioradialis muscle, underlining the variability in JMA presentations. A precise diagnosis is contingent upon clinical criteria, dynamic MRI, and electrophysiological findings. Recognizing these variations is crucial for early detection and appropriate management of the disease.

Efficacy of Anterior Cervical Discectomy and Fusion for Female Patients with Hirayama Disease

OBJECTIVE

To compare the preoperative and postoperative hand function and radiographic parameters in female patients with Hirayama disease (HD).

METHODS

Consecutive female patients with HD undergoing anterior cervical discectomy and fusion were followed up. The postoperative hand functional data were obtained from the last follow-up, whereas the postoperative radiographic data were obtained from the examinations in 3- or 6-month follow-up after surgical treatments. The preoperative and postoperative data of hand functional and radiographic assessments were collected and compared between them. Logistic regression analysis was used to clear potential risk factors for surgical treatment.

RESULTS

In all, 15 female patients with HD were included in the follow-up study over 9 years. Significant differences were found in total scores (P < 0.001) and all 6 dimensions, including function (P = 0.003), activities of daily life (P = 0.002), work (P = 0.003), satisfaction (P = 0.002), appearance (P = 0.005), and HD-specific hand symptoms (P = 0.001) in hand functional assessment. The comparison of C2-C7 Cobb angle was statistically different (P = 0.042) in radiographic assessments. The course of illness was of marginal significance (P = 0.065) with curative effect of surgical treatment in logistic regression analysis.

CONCLUSIONS

Anterior cervical discectomy and fusion is an effective way to treat female patients with HD, and the course of illness may be correlated with the efficacy of surgery. For some female patients with HD with a clear diagnosis, early surgical treatment is worthy of clinical consideration.

Do patients with Hirayama disease require surgical treatment? A review of the literature

The main clinic characteristic of Hirayama disease (HD) is atrophy of the distal muscles in the upper limbs. Recently, an increasing number of HD cases have been reported. Many HD patients have persistently progressive symptoms and conservative treatments failed. This article aims to review the current status of the field and summarizes the main surgical treatment options for patients with HD. A comprehensive search of the PubMed and the Web of Science databases was conducted from their inception to September 15th, 2022. Search terms included "juvenile muscular atrophy of upper extremity", "Hirayama disease" and "surgery". A total of 169 relevant publications were identified and 29 articles were finally reviewed. Current surgical treatments for HD are either anterior cervical surgery or posterior cervical surgery. The two approaches can effectively stop the disease. However, no studies have compared the advantages and limitations of the two surgical methods. The previous view that HD can be improved with conservative treatment has been challenged. In many studies, surgical treatment has been shown to improve the hand function in patients with HD. However, there is still controversy about the methods of anterior and posterior cervical surgery. Future research could focus on exploring the advantages and limitations of different surgeries.

Hirayama-like disease in the thoracic spine

Hirayama disease is a cervical flexion myelopathy that typically causes upper extremity weakness in young male patients. We present two male patients (age 15 and 29) with MRI findings of thoracic ligamentous laxity similar in appearance to Hirayama disease. However, patients presented with atypical symptoms, specifically back pain and paresthesia of the upper and/or lower extremities, likely correlating to the abnormal thoracic spinal levels involved. Flexion/extension MRI sequences demonstrated the forward displacement of the dorsal dura and compression the thoracic cord with prominence of the posterior epidural space and venous plexus. Follow-up MRAs were negative for a spinal vascular malformation. Patients were managed conservatively with no surgical intervention. Clinical history, thoracic MRI, and follow-up flexion and angiographic imaging sequences may help confirm a diagnosis of Hirayama-like thoracic ligamentous laxity.