scholarly journals Spinal Cord Edema in Atypical Cervical Spondylotic Myelopathy--the Facts Behind the Unusual MR Findings: Case Report and Review of the Literature

Author(s):  
Qingrun Zhu ◽  
Xin Zhou ◽  
Shiwei Ren ◽  
Dachuan Wang ◽  
Feng Wang

Abstract Purpose We report the case of a young man with a slow progression of cervical spondyloticmyelopathy (CSM). Cervical magnetic resonance imaging (MRI) revealed a mild cervical discbulgingat C5–C6 and an area of atypically enlarged intramedullary high signal intensity extending from C4–C7 (T2-weighted) with contrast enhancement at C5–C6 (T1-weighted). Therefore, neurologic and radiologic diagnoses favored demyelinating diseases. Interference occurred to the diagnosis of CSM.Methods This was a retrospective case study with follow-up examination and MRI at 3 months, 1 year and 2 years postoperatively.Results Thepatient’s symptoms improved immediately postoperatively. The functional result according to the modified Japanese Orthopedic Association (JOA) score improved from 10 to 13 within 3 months. He continued to improve neurologically over the first postoperative year. Two years postoperatively, a T2-weighted MRI showed that the edema signal had disappeared completely , and a fat-saturated T2-weighted MRI showed only slight abnormal signal. The numbness and weakness of the extremities had improved, and his JOA score was 16. Conclusions Spinal cord edema is occasionally seen with CSM. In the case presented, the contrast enhancement was localized at the site of the greatest narrowing of the spinal canal and compression of the spinal cord. This coincidence was the best indicator of a mechanical cause of the spinal cord changes. This feature should increase physician’s confidence in distinguishing CSM from intramedullary tumors and myelitis. Surgical decompression may be beneficial in improving neurologic outcomes.

1991 ◽  
Vol 27 (5) ◽  
pp. 626
Author(s):  
Du Whan Choe ◽  
Hee Young Hwang ◽  
Hyeon Kyeong Lee ◽  
Moon Hee Han ◽  
In One Kim ◽  
...  

1985 ◽  
Vol 2 (1) ◽  
pp. 45-58 ◽  
Author(s):  
JACOB ABRAHAM ◽  
AIYLAM S. BALASUBRAMANIAN ◽  
D.R. THEODORE ◽  
SHANMUGAM NAGARAJAN ◽  
C.A. APTE ◽  
...  

1987 ◽  
Vol 66 (6) ◽  
pp. 830-834 ◽  
Author(s):  
John L. Doppman ◽  
Giovanni Di Chiro ◽  
Andrew J. Dwyer ◽  
Joseph L. Frank ◽  
Edward H. Oldfield

✓ Magnetic resonance imaging (MRI) was performed on 12 patients with spinal arteriovenous malformations (AVM's). Six lesions were intramedullary, five were dural, and one was in a posterior extramedullary location. Serpentine filling defects similar to the classic myelographic findings were demonstrated within the high-signal cerebrospinal fluid on T2-weighted coronal scans. The intramedullary nidus was identified by MRI as an area of low-signal intensity within the cord in all six intramedullary AVM's. Neither the dural nor the posterior extramedullary lesions showed intramedullary components. It is concluded that MRI may noninvasively provide the initial diagnosis of a spinal AVM and distinguish intramedullary from dural and extramedullary lesions.


2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Chih-Ming Lin

Methomyl is a potent pesticide that is widely used in the field of agriculture. The systemic toxic effects of methomyl have been well described. However, the neurological effects of methomyl intoxication are not well understood. In this study, we report a 61-year-old Taiwanese man sent to our emergency department because of altered mental status. His family stated that he had consumed liquid methomyl in a suicide attempt. He was provided cardiopulmonary resuscitation because of unstable vital signs. He was then sent to an intensive care unit for close observation. On the second day of admission, he regained consciousness but exhibited irregular limb and torso posture. On the sixth day, he started to complain of blurred vision. An ophthalmologist was consulted but no obvious abnormalities could be identified. On suspicion of cerebral disease, a neurologist was consulted. Further examination revealed cortical blindness and decorticate posture. Cerebral magnetic resonance imaging (MRI) was arranged, which identified bilateral occipital regions lesions. The patient was administered normal saline and treated with aspirin and piracetam for 3 weeks in hospital. During the treatment period, his symptom of cortical blindness resolved, whereas his decorticate posture was refractory. Follow-up brain MRI results supported our clinical observations by indicating the disappearance of the bilateral occipital lesions and symmetrical putaminal high signal abnormalities. In this article, we briefly discuss the possible mechanisms underlying the cerebral effects of methomyl poisoning. Our study can provide clinicians with information on the manifestations of methomyl intoxication and an appropriate treatment direction.


PEDIATRICS ◽  
1986 ◽  
Vol 78 (2) ◽  
pp. 251-256
Author(s):  
Roger J. Packer ◽  
Robert A. Zimmerman ◽  
Leslie N. Sutton ◽  
Larissa T. Bilaniuk ◽  
Derek A. Bruce ◽  
...  

Correct diagnosis of spinal cord disease in childhood is often delayed, resulting in irreversible neurologic deficits. A major reason for this delay is the lack of a reliable means to noninvasively visualize the spinal cord. Magnetic resonance imaging (MRI) should be useful in the evaluation of diseases of the spinal cord. A 1.5 Tesla MRI unit with a surface coil was used to study 41 children, including eight patients with intrinsic spinal cord lesions, eight patients with masses compressing the cord, 12 patients with congenital anomalies of the cord or surrounding bony structures, three patients with syrinxes, and three patients with vertebral body abnormalities. Intrinsic lesions of the cord were well seen in all cases as intrinsic irregularly widened, abnormally intense cord regions. MRI was helpful in following the course of disease in patients with primary spinal cord tumors. Areas of tumor were separable from syrinx cavities. Extrinsic lesions compressing the cord and vertebral body disease were also well visualized. Congenital anomalies of the spinal cord, including tethering and lipomatous tissue, were better seen on MRI than by any other radiographic technique. MRI is an excellent noninvasive "screening" technique for children with suspected spinal cord disease and may be the only study needed in many patients with congenital spinal cord anomalies. It is also an excellent means to diagnose and follow patients with other forms of intra- and extraspinal pathology.


Neurographics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 72-74
Author(s):  
A.K. Kirsch ◽  
S.M. Allison ◽  
S.A. Kilanowski

Subacute combined degeneration is uncommonly a result of nitrous oxide abuse and presents with high signal in the dorsal columns of the spinal cord on T2-weighted MR imaging. We present a case of subacute combined degeneration in a young patient who abused nitrous oxide, which is an uncommon cause and infrequently seen in this patient population. Symptoms are often reversible with treatment of vitamin B12, and radiologists should be aware of these findings to avoid delay in treatment.


2021 ◽  
Vol 12 (3) ◽  
pp. 2083-2087
Author(s):  
Ali Alshararni

The case report demonstrates the issue of Khalid Ali, who is a citizen of Yamen, explicitly living in Saudi Arabia. He is 38 years, weighs 82kgs, and of 162 cm in height. He is a sales professional and married with two kids. Khalid Ali has been living healthy until two years ago when he started experiencing pains in his lower extremities accompanied by numbness. He was treated, and everything went back to normal until soon when the case came back after the administration of the Pfizer vaccine as a preventive measure for COVID-19 disease. The consequence of the administration of the Pfizer vaccine resulted in severe pain and weaknesses in his legs and severe headache on the second day, which resulted in him being put on an ICU after 48 hours since he was almost paralyzed. A series of tests were conducted on him, including magnetic resonance imaging (MRI), hematology, and biochemistry which involved Cerebrospinal Fluid (CSF) protein test. MRI findings were significant since they indicated acute inflammation on the spine observed on the dorsal spinal cord with contrast and lumbosacral spinal cord. All the hematology tests turned out to be expected. Biochemistry conducted tests were similarly standard except for CSF protein which was highly abnormal. The combination of the high abnormal CSF protein test and acute inflammation of the spine observed from the MRI findings were confirmed evidence of acute transverse myelitis as a result of the administration of the Pfizer vaccine.


2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Minghao Shao ◽  
Jun Yin ◽  
Feizhou Lu ◽  
Chaojun Zheng ◽  
Hongli Wang ◽  
...  

Objective.To evaluate the forward shifting of cervical spinal cords in different segments of patients with Hirayama disease to determine whether the disease is self-limiting.Methods.This study was performed on 11 healthy subjects and 64 patients. According to the duration, the patients were divided into 5 groups (≤1 year, 1-2 years, 2-3 years, 3-4 years, and ≥4 years). Cervical magnetic resonance imaging (MRI) of flexion and conventional position was performed. The distances between the posterior edge of the spinal cord and the cervical spinal canal (X), the anterior and posterior wall of the cervical spinal canal (Y), and the anterior-posterior (A) and the transverse diameter (B) of spinal cord cross sections were measured at different cervical spinal segments (C4 to T1).Results.In cervical flexion position, a significant increase inX/Yof C4-5 segments was found in groups 2–5, the C5-6 and C6-7 segments in groups 1–5, and the C7-T1 segments in group 5 (P<0.05). The degree of the increasedX/Yand cervical flexionX/Yof C5-6 segments were different among the 5 groups (P<0.05), which was likely due to rapid increases inX/Yduring the course of Hirayama’s disease.Conclusion.TheX/Ychange progression indicates that Hirayama disease may not be self-limiting.


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