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Tekin B, Ansen G, Ormeci T, Yilmaz NH, Sakul BU. Re-evaluation of the symptoms of Hirayama disease through anatomical perspective. Intractable Rare Dis Res 2023; 12:62-66. [PMID: 36873670 PMCID: PMC9976093 DOI: 10.5582/irdr.2022.01117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Hirayama disease is a rare disease of the anterior horn motor neuron caused by compression of the cervical spinal cord when the neck is flexed. Cervical myelopathy may accompany the disease. It is characterized by symmetrical or asymmetrical muscle weakness and atrophy of muscles innervated by lower cervical and upper thoracic motor neurons. We recorded two male cases of Hirayama disease between the ages of 15 and 21 based on magnetic resonance imaging (MRI) features obtained from the cervical neutral state and from the flexion position which appeared in the right upper extremity. Loss of strength and atrophy in the right upper extremities was existent in clinical findings of these patients. When MRI was taken in the flexion position, there were dilated veins as hypointense signal void on T2 weighted series in posterior epidural area. The contrast enhancement was seen on these veins. It was observed that the posterior dura was displaced anteriorly and the anterior subarachnoid space was narrow. In cases which show clinical findings such as atrophy and loss of strength, having normal MRI results obtained in the neutral position makes it difficult to diagnose Hirayama Disease. In case of a suspicion of Hirayama disease the diagnosis can be made more easily by MRI taken in the flexion position. These case reports aim to bring Hirayama disease to mind and optimize the management of affected individuals.
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Affiliation(s)
- Bahar Tekin
- Department of Anatomy, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Department of Anatomy, School of Medicine, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
- Address correspondence to:Bahar Tekin, Department of Anatomy, Faculty of Medicine, Istanbul Medipol University, Kavacık, Göztepe Mah, Atatürk Cd. No:40, 34810 Beykoz/Istanbul, Turkey. E-mail:
| | - Gamze Ansen
- Department of Anatomy, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Department of Anatomy, School of Medicine, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Tugrul Ormeci
- Department of Radiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Nesrin Helvaci Yilmaz
- Department of Neurology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Bayram Ufuk Sakul
- Department of Anatomy, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Kandukuri GR, Acosta NR. Significance of Dynamic Imaging in Diagnosis of Hirayama Disease: A Rare Case Report and Literature Review. Kans J Med 2020; 13:58-60. [PMID: 32226583 PMCID: PMC7100947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/12/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gautham R. Kandukuri
- Truman Medical Center Hospital Hill, Department of Radiology, Kansas City, MO,University of Missiouri-Kansas City, School of Medicine, Kansas City, MO
| | - Natasha R. Acosta
- Truman Medical Center Hospital Hill, Department of Radiology, Kansas City, MO
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Salome M, Barkhof F, Visser L. Hirayama disease; an atypical clinical manifestation of a cervical myelopathy with typical MRI features. BMJ Case Rep 2017; 2017:bcr-2016-217780. [PMID: 28052949 DOI: 10.1136/bcr-2016-217780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mariet Salome
- Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - Frederik Barkhof
- Department of Radiology, VU Medical Centre, Amsterdam, The Netherlands
| | - Leo Visser
- Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
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Anuradha S, Fanai V. Hirayama Disease: A Rare Disease with Unusual Features. Case Rep Neurol Med 2016; 2016:5839761. [PMID: 28097028 PMCID: PMC5209606 DOI: 10.1155/2016/5839761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/04/2016] [Indexed: 11/20/2022] Open
Abstract
Hirayama disease, also known as monomelic amyotrophy (MMA), is a rare cervical myelopathy that manifests itself as a self-limited, asymmetrical, slowly progressive atrophic weakness of the forearms and hands predominantly in young males. 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 atrophy with asymmetric flattening. We report a case of Hirayama disease in a 25-year-old Indian man presenting with gradually progressive asymmetrical weakness and wasting of both hands and forearms along with unusual features of autonomic dysfunction and upper motor neuron lesion.
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Affiliation(s)
- S. Anuradha
- Department of Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi 110002, India
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