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Case Report | Radiology and Medical Imaging Sciences | Volume 15 Issue 6, June 2026 | Pages: 220 - 224 | India
Unmasking Hirayama Disease with Dynamic 3.0 Tesla Flexion and Contrast-Enhanced MRI: A Case Report
Abstract: Hirayama disease is an uncommon, self-limiting flexion myelopathy that typically affects young males and may mimic motor neuron disease when routine neutral-position cervical MRI is non-diagnostic. We report a 21-year-old male who presented with one year of insidious difficulty in lifting weight with the left hand, with no sensory symptoms and no history of trauma or surgery. On clinical suspicion of a motor neuron disorder, riluzole had been started before MRI evaluation. Dynamic cervical spine MRI performed on a 3.0 Tesla scanner demonstrated subtle T2 hyperintensity and focal atrophy of the lower cervical cord on neutral imaging. Flexion MRI revealed anterior translation of the posterior dura, loss of dural attachment, development of an enlarged posterior epidural space measuring approximately 6.3 mm, bowstringing and compression of the lower cervical cord at C6-C7, and heterogeneous post-contrast enhancement of the posterior epidural space, representing engorged epidural venous plexus. The posterior epidural abnormality significantly reduced on extension, confirming its dynamic nature. This case highlights the value of dynamic flexion MRI, with contrast-enhanced imaging as a useful adjunct, in establishing the diagnosis and preventing misclassification as progressive motor neuron disease.
Keywords: Hirayama disease, dynamic MRI, flexion myelopathy, posterior epidural venous plexus, cervical cord atrophy
How to Cite?: Dr. Arpit Kushwaha, Dr. Harguneet Kaur, Dr. Madan Manmohan, "Unmasking Hirayama Disease with Dynamic 3.0 Tesla Flexion and Contrast-Enhanced MRI: A Case Report", Volume 15 Issue 6, June 2026, International Journal of Science and Research (IJSR), Pages: 220-224, https://www.ijsr.net/getabstract.php?paperid=SR26604113534, DOI: https://dx.dx.doi.org/10.21275/SR26604113534