Voluminous free disk fragment mimicking an extradural tumor.

A 56-year-old man presented with a rare case of a voluminous herniated disc fragment mimicking an intraspinal extradural tumor on magnetic resonance (MR) imaging. He had experienced low back pain and sciatica in his right leg for 12 months, which exacerbated suddenly 4 days before admission accompanied by right quadriceps muscle weakness. MR imaging with gadolinium demonstrated a tumor-like longitudinal lesion, extending from the L1-2 to the L3-4 intervertebral disc spaces and occupying most of the right half of the vertebral canal. L2 and L3 laminectomy, as well as L2-3 right foraminotomy, were performed. We were prepared for an oncological operation, but instead, a huge disc fragment was removed en bloc from the right epidural space. The patient's postoperative course was uneventful and he demonstrated full neurological recovery within 2 months. Sequestrated lumbar disc fragments must be considered in the differential diagnosis of longitudinal extradural mass lesions in the spinal canal independently of their size. MR imaging with contrast medium can differentiate herniated disc from tumors and other epidural lesions. Nevertheless, nontypical sequestrated disc herniations are extremely rare and can be misinterpreted.

Posttraumatic Benedikt's syndrome: a rare entity with unclear anatomopathological correlations.

BACKGROUND: This study sought to present a very rare case of a posttraumatic midbrain lesion producing a debilitating constellation of symptoms identified as Benedikt's syndrome. METHODS: A 20-year-old woman with traumatic brain injury presented with ipsilateral internal and external ophthalmoplegia, and contralateral hemiataxia, proprioception disturbances, hypertonicity, slight hemiparesis, and hyperactive tendon reflexes. A bibliographic search was performed in PubMed. RESULTS: Neuroimaging revealed a left midbrain lesion at the level of the superior colliculi. In the literature, virtually all Benedikt's syndrome cases, which are rare anyway, are due to midbrain infarcts (basilar or posterior cerebral artery branches). There is only one case from 1963, reported as a posttraumatic Benedikt-type dyskinesia (French language). The historical evolution of the anatomopathologic correlations of the syndrome is also discussed. CONCLUSIONS: Benedikt's syndrome is a very rare condition, usually of vascular etiology. Our case is just the second one of traumatic pathogenesis ever reported, the first in the English language literature.