Flexion MRI Essential for Hirayama Disease Diagnosis in Adolescents; Neutral MRI Insufficient

In 3 adolescents with Hirayama disease, neutral cervical MRI was nondiagnostic. Flexion MRI revealed anterior displacement of the posterior dural sac, enlargement of the posterior epidural space, and prominent epidural veins causing cord compression.

• Retrospective case series of 3 adolescent patients with progressive distal upper extremity weakness.
• All had electrophysiological findings suggestive of lower cervical cord pathology.
• Flexion MRI findings were essential for diagnosis; neutral MRI alone was insufficient.

Small retrospective case series; no comparator group, limited generalizability.

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