*69-year-old male with bilateral upper extremity hemiparesis.
What is the most likely diagnosis?
Answer
Answer:
-Diffuse idiopathic skeletal hyperostosis (DISH).
-Cervical canal stenosis and myelomalacia at C2-C3 and C3-C4 levels.
Case Discussion:
CT and MRI revealed diffuse idiopathic skeletal hyperostosis and cervical canal stenosis and myelomalacia at C2-C3 and C3-C4 levels.
Also known as Forestier’s disease, diffuse idiopathic skeletal hyperostosis (DISH) is a frequent condition characterized by bony proliferation at sites of tendinous and ligamentous insertion of the spine affecting elderly individuals. DISH is classically characterized by the flowing ossification of the anterior longitudinal ligament involving the thoracic spine and enthesopathy. There is no involvement of the sacroiliac synovial joints. It most frequently affects the elderly, mainly 6th to 7th decades, with a male predominance (1). The cervical and thoracic (particularly T7-11) spines are affected. Additionally, enthesopathy may be identified in the pelvis and extremities (2).
References:
1. Cammisa M, De serio A, Guglielmi G. Diffuse idiopathic skeletal hyperostosis. Eur J Radiol. 1998;27 Suppl 1 : S7-11.
2. Taljanovic MS, Hunter TB, Wisneski RJ et-al. Imaging characteristics of diffuse idiopathic skeletal hyperostosis with an emphasis on acute spinal fractures: review. AJR Am J Roentgenol. 2009;193 (3): S10-9, Quiz S20-4.