Flexion cervical spine MRI in Hirayama disease showing expansion of the dural venous plexus with presumed chronic ischaemic damage preferentially involving the anterior horn cells supplying the distal arm. Flexion cervical spine MRI in Hirayama disease showing expansion of the dural venous plexus with presumed chronic ischaemic damage preferentially involving the anterior horn cells supplying the distal arm. Martin R Turner, and Kevin Talbot Pract Neurol 2013;13:153-164 ©2013 by BMJ Publishing Group Ltd