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MR ‘scalpel sign’ of spinal arachnoid web
  1. Thomas Morrison1,
  2. Raka Datta2,
  3. Lynette Masters3,
  4. Mike Boggild4,
  5. Stephen Reddel5,
  6. Jeffrey Brennan1
  1. 1 Neurosurgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  2. 2 Neurology, Townsville University Hospital, Townsville, Queensland, Australia
  3. 3 Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
  4. 4 Townsville Hospital, Queensland Health, Townsville, Queensland, Australia
  5. 5 Neurology, Brain and Mind Research Institute, Sydney, New South Wales, Australia
  1. Correspondence to Dr Thomas Morrison, Neurosurgery, Royal Prince Alfred Hospital, Camperdown, NSW 2042, Australia; tommorrison.au{at}gmail.com

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Spinal arachnoid web is a rare and reversible cause of myelopathy and syringomyelia. Intradural, extramedullary transverse bands exert focal pressure on the spinal cord, disrupt the flow of Cerebrospinal fluid (CSF) in the subarachnoid space and by doing so can lead to the formation of a syrinx. Patients present with myelopathic symptoms including numbness, weakness and gait disturbance. MR imaging can show a characteristic ‘scalpel sign’ on sagittal T2 images. Traditional sequences rarely show the web itself, requiring clinicians to infer its presence.1 2 For patients with progressive symptoms, the only treatment is surgical decompression, generally with good clinical outcomes.3 We describe three patients who presented in the outpatient setting.

Patient A: A 65-year-old woman had a 1 year of burning dysaesthetic pain in the trunk and flank and unsteadiness when walking. She was mildly spastic with lower limb hyperreflexia and reduced proprioception …

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Footnotes

  • Contributors TM and RD wrote the draft paper and compiled the figures. LM, BM, SR and JB revised the draft paper. JB was the operating surgeon for each case. TM is the guarantor of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Graham Flint, Birmingham, UK.