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CC BY 4.0 · Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1805093
Letter to the Editor

Ecchordosis Physaliphora and Posttraumatic Headache: A Diagnostic Challenge in Neurotrauma

Carlos Enrique Hernández Borroto 
1   Department of Medicine, Integramédica S. A., Santiago de Chile, Chile
,
Orquidia Reyes de Hernández
2   Department of Medical Diagnosis, GME JDS 2012 C. A., Caracas, Venezuela
,
Yuri Medrano Plana 
3   Department of Morphophysiology, School of Medicine, Universidad Laica Eloy Alfaro De Manabí, Manta, Ecuador
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Ecchordosis physaliphora (EP) is a rare entity of the central nervous system (CNS) originating from ectopic remnants of the notochord. During embryonic development, the notochord induces the formation of the neural tube through molecular signals such as Sonic Hedgehog. While it typically degenerates and persists only in the nucleus pulposus of the intervertebral discs, its remnants may localize in abnormal sites. EP most commonly occurs in the retroclival prepontine cistern, although it can appear anywhere along the notochordal axis, from the base of the skull to the sacrum. This benign lesion, with a unique histology and specific location, is usually asymptomatic, making it a diagnostic challenge for clinicians and researchers.[1] [2]

The clinical manifestations of EP include headache, cerebrospinal fluid (CSF) rhinorrhea, diplopia, sixth cranial nerve palsy, and hemiparesis. Less frequent symptoms, such as dizziness, tinnitus, and paresthesia, may also occur. Neuroimaging is the primary diagnostic tool and allows differentiation from other neurological conditions, aiding in the decision between conservative management with serial magnetic resonance imaging (MRI) or surgical resection with biopsy. In more severe cases, EP may progress to malignant chordoma, necessitating timely surgical intervention.[2] A case of EP discovered as an incidental finding in a patient with posttraumatic headache secondary to neurotrauma is presented below.



Publication History

Article published online:
26 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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