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Choi JW, DeSimone KE, Dacumos VM, Hoshide RR, Qiao Y, Hui FK. Scalpellum occulta: A rare case of dorsal spinal arachnoid web without the scalpel sign. Radiol Case Rep 2024; 19:1552-1555. [PMID: 38317702 PMCID: PMC10839584 DOI: 10.1016/j.radcr.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
Spinal arachnoid web is a rare condition characterized by extramedullary bands of arachnoid tissue at the level of the dorsal thoracic spinal cord that may lead to progressive, permanent neurological deficits. To date, this condition has been radiographically characterized by a scalpel sign, which has been pathognomonic in all reported cases of spinal arachnoid webs. In this case, we report the first known patient with confirmed spinal arachnoid web without radiographic evidence of the scalpel sign. In reporting our finding, we encourage a higher clinical suspicion for spinal arachnoid web in patients presenting with progressive thoracic myelopathy following trauma, and radiographic evidence of ventrally displaced spinal cord and turbulent cerebrospinal fluid flow, even in the absence of a scalpel sign.
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Affiliation(s)
- Joo Won Choi
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Kulani E. DeSimone
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Vianca Mae Dacumos
- College of Tropical Agriculture and Human Resources, University of Hawaiʻi at Mānoa, 3050 Maile Way, Honolulu, HI 96822, USA
| | - Reid R. Hoshide
- Department of Neurosurgery, The Queen's Medical Center, 550 South Beretania Street, Honolulu, HI 96813, USA
| | - Yang Qiao
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin Street Suite #1200, Houston, TX 77030, USA
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Ferdinand K. Hui
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
- Department of Neurointerventional Surgery, The Queen's Medical Center, 550 South Beretania Street, Honolulu, HI 96813, USA
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