scholarly journals Diagnosis and Spontaneous Resolution of an Epidural Hematoma in a Patient Presenting after Cervical Epidural Steroid Injection

2018 ◽  
pp. 213-219
Author(s):  
Ivan Urits
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Neck Pain ◽  
Epidural Hematoma ◽  
Steroid Injection ◽  
Spontaneous Resolution ◽  
Resonance Imaging ◽  
Radiographic Findings ◽  
History Of ◽  
Epidural Steroid

While not a cure for the underlying spinal pathology, cervical epidural steroid injections (CESI) are an important minimally invasive treatment for neck pain with radiculopathy. Although CESIs are considered safe, cervical epidural hematoma (CEH) is a major complication and has previously been reported. Patients, who develop CEH, present with acute neck pain and upper extremity radiculopathy. A prolonged time to treatment may lead to worsened neurological outcome. Diagnostic magnetic resonance imaging and surgical decompression is the mainstay of treatment. This report presents a patient with a history of chronic neck pain and repeat cervical injections, who presented with increased neck pain and upper extremity weakness after undergoing a CESI. Initial radiographic findings were complicated and inconclusive of a definitive epidural hematoma. With conservative management, the patient showed signs of clinical improvement and ultimately had spontaneous resolution of his CEH. Though CEH are frequently rapidly progressing and most often surgically decompressed, some acutely presenting cases may be approached conservatively. Though MRI is an important diagnostic tool for CEH, interpretation of radiographic findings, following a recent CESI, may be challenging due to distortion of the epidural space anatomy. Patients with a history of multiple cervical epidural injections may have an increased risk for the development of CEH. Key words: Cervical epidural steroid injection, cervical epidural hematoma, spontaneous resolution, conservative management, magnetic resonance imaging, complication

scholarly journals Association of History Taking and Accuracy of the Interpretation of Cervical and Lumbar Magnetic Resonance Imaging

2020 ◽  
Vol 8 (B) ◽  
pp. 676-682
Author(s):  
Mohammad Hossein Daghighi ◽  
Mohammad Asghari Jafarabadi ◽  
Mitra Shoja Sefat
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Neck Pain ◽  
Clinical History ◽  
Diagnostic Methods ◽  
Imaging Method ◽  
Resonance Imaging ◽  
Disk Herniation ◽  
Canal Stenosis ◽  
History Of

BACKGROUND: Disk herniation leading to radiculopathy is one of the most important causes of neck and back pain, requiring specific diagnostic tests. Magnetic resonance imaging (MRI) is one of these diagnostic methods. Interpreting the findings of this imaging method by an experienced skilled person is very important. AIM: The purpose of this study was to investigate the role of history on the accuracy of the lumbar or cervical MRI reports in patients with back and neck pain referring to the radiology department. METHODS: This study was performed on patients with complaints of lumbar or neck pain that MRI had been performed for them. At first, the MRI was studied by the residents of the 2nd and 3rd years and then a radiologist as a routine, respectively. From 4 to 6 months later, patients’ clinical history was presented to the same students and professors and MRI was re-reported. Statistical differences were evaluated and analyzed using SPSS software version 20. RESULTS: Out of 150 patients with mean age of 42.56 ± 10.65, 87 patients (58%) were female and 63 (42%) were male. Most of the patients were between the ages of 40 and 50 years (34.66%). The most common clinical symptom of patients was waist and neck pain followed by sensory disturbances of the extremities. The most pathologic changes found was disk bulging in 28.8% of patients (68 cases). In terms of lumbar canal stenosis, the most cases were in the L4-L5 levels of the moderate type. The most reported cases of cervical stenosis have been mild. Disk herniation and DOCP were two main factors causing canal stenosis in the study patients. Statistical difference in the MRI reports performed by the residents on most of the variables was statistically significant before and after knowing the clinical history of the patient (p < 0.05). However, this difference was less noted in the reports of the radiologists. CONCLUSION: The results of this study showed that knowing the history of patients in interpreting the results of MRI in patients with vertebral disk hernia is misleading and will lead to many false positive and negative results, especially for radiology residents. It is recommended that the residents and radiologists consider the MRI films before focusing on the biographies and clinical features of the patient, to prevent the occurrence of bias and to increase the accuracy of the reports.

scholarly journals A Case Report: The Challenging Diagnosis of Spontaneous Cervical Epidural Hematoma

2020 ◽  
Vol 4 (3) ◽  
pp. 428-431
Author(s):  
Francis Counselman ◽  
Julie Tondt ◽  
Harry Lustig
Keyword(s):  
Magnetic Resonance Imaging ◽  
Emergency Department ◽  
Case Report ◽  
Neck Pain ◽  
Epidural Hematoma ◽  
Correct Diagnosis ◽  
Sudden Onset ◽  
Resonance Imaging ◽  
History Of ◽  
Leg Weakness

Introduction: We present the case of a patient with a spontaneous cervical epidural hematoma that presented with neck pain and mild, left arm parasthesia. Case Report: A 59-year old man presented with sudden onset of severe neck pain, without history of injury or trauma. The patient also complained of associated left arm parasthesias that progressed to left arm and leg weakness while in the emergency department. Multiple diagnoses were considered and worked up; eventually the correct diagnosis was made with magnetic resonance imaging of the cervical spine. Conclusion: Spontaneous cervical epidural hematoma typically presents with neck pain, and variable neurologic complaints. This case illustrates the challenge in making this uncommon but serious diagnosis.

Magnetic Resonance Imaging of Pseudo-impingement of Rotator Cuff with Strength Training

2019 ◽  
Vol 1 ◽  
pp. 2-6
Author(s):  
Asad Naqvi ◽  
Timothy Ariyanayagam ◽  
Mir Akber Ali ◽  
Akhila Rachakonda ◽  
Hema N. Choudur
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Rotator Cuff ◽  
Strength Training ◽  
Radiology Department ◽  
Resonance Imaging ◽  
Subacromial Space ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Training Exercises

Objective: The objective of this study was to outline a novel unique concept of secondary impingement of the muscles, myotendons, and tendons of the rotator cuff from hypertrophy as a result of strength training exercises. Methods: In this retrospective observational study, 58 patients were referred for an magnetic resonance imaging (MRI) by the orthopedic surgeon to the radiology department over a period of 1½ years. All patients gave a history of strength training exercises and presented with clinical features of rotator cuff impingement. Results: We identified features of hypertrophy of rotator cuff muscles, myotendons, and tendons in 12 of these 58 patients. This was the only abnormality on MRI. The hypertrophy of rotator cuff muscles and tendon bulk completely filling the subacromial space to the point of overfilling and resulting in secondary compressive features. Conclusion: Rotator cuff impingement is a common phenomenon that can occur with various inlet and outlet pathological conditions. However, rotator cuff impingement may also result from muscle and tendon hypertrophy from strength training regimens. Hypertrophy of the rotator cuff can result in overfilling of the subacromial space, leading to secondary impingement, which we have termed as “pseudo-impingement.”

Technical and radiographic considerations for magnetic resonance imaging–guided focused ultrasound capsulotomy

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Benjamin Davidson ◽  
Karim Mithani ◽  
Yuexi Huang ◽  
Ryan M. Jones ◽  
Maged Goubran ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Focused Ultrasound ◽  
Neurosurgical Procedures ◽  
Lesion Volume ◽  
Angle Of Incidence ◽  
Resonance Imaging ◽  
Radiographic Findings ◽  
Compulsive Disorder ◽  
Skull Thickness

OBJECTIVEMagnetic resonance imaging–guided focused ultrasound (MRgFUS) is an emerging treatment modality that enables incisionless ablative neurosurgical procedures. Bilateral MRgFUS capsulotomy has recently been demonstrated to be safe and effective in treating obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). Preliminary evidence has suggested that bilateral MRgFUS capsulotomy can present increased difficulties in reaching lesional temperatures as compared to unilateral thalamotomy. The authors of this article aimed to study the parameters associated with successful MRgFUS capsulotomy lesioning and to present longitudinal radiographic findings following MRgFUS capsulotomy.METHODSUsing data from 22 attempted MRgFUS capsulotomy treatments, the authors investigated the relationship between various sonication parameters and the maximal temperature achieved at the intracranial target. Lesion volume and morphology were analyzed longitudinally using structural and diffusion tensor imaging. A retreatment procedure was attempted in one patient, and their postoperative imaging is presented.RESULTSSkull density ratio (SDR), skull thickness, and angle of incidence were significantly correlated with the maximal temperature achieved. MRgFUS capsulotomy lesions appeared similar to those following MRgFUS thalamotomy, with three concentric zones observed on MRI. Lesion volumes regressed substantially over time following MRgFUS. Fractional anisotropy analysis revealed a disruption in white matter integrity, followed by a gradual return to near-baseline levels concurrent with lesion regression. In the patient who underwent retreatment, successful bilateral lesioning was achieved, and there were no adverse clinical or radiographic events.CONCLUSIONSWith the current iteration of MRgFUS technology, skull-related parameters such as SDR, skull thickness, and angle of incidence should be considered when selecting patients suitable for MRgFUS capsulotomy. Lesions appear to follow morphological patterns similar to what is seen following MRgFUS thalamotomy. Retreatment appears to be safe, although additional cases will be necessary to further evaluate the associated safety profile.

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