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Dokponou YCH, Ontsi Obame FL, Takoutsing B, Mustapha MJ, Nyalundja AD, Elmi Saad M, Badirou OBA, Adjiou DKFDP, Agada Kpègnon N, Djimrabeye A, Bankole NDA. Spinal cord infarction: A systematic review and meta-analysis of patient's characteristics, diagnosis accuracy, management, and outcome. Surg Neurol Int 2024; 15:325. [PMID: 39372971 PMCID: PMC11450783 DOI: 10.25259/sni_477_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 08/06/2024] [Indexed: 10/08/2024] Open
Abstract
Background Acute spinal cord infarction (SCI) is a rare ischemic vascular lesion. It is difficult to diagnose during the acute phase because the clinical features can vary widely, and the diffusion-weighted imaging of spinal cord magnetic resonance imaging (MRI) often fails to detect any obvious abnormality. The first aim of this study was to describe the SCI patients' characteristics, evaluate the accuracy of its diagnosis tools and management, and then find the strength of the effect of spinal surgical decompression on the patient's outcome. Methods A PubMed keyword and Boolean search using ("spinal cord infarction" OR "spinal cord ischemia" AND diagnosis OR management OR outcome) returned 221,571 results by applying filters. We added 17,400 results from Google Scholar. Fourteen studies were included in the quantitative meta-analysis of mean differences. Results The Time to Nadir was <6 h (56.1%), 6-12 h (30.7%), 12-72 h (5.4%), and more than 72 h (7.8%). The higher proportion of Owl's eye findings in the MRI was reported at the cervical level (39.6%) and thoracic level (22.9%) P = 0.031. The T2DWI has a moderate accuracy (area under the curve = 0.835) in detecting the T2 hypersignal intensity (T2HSI) at the hyperacute time to NADIR (<6 h). The median modified Rankin Scale (mRS) at admission was 3 (2-3), and after a follow-up duration of 12 months (6-15.5), the median mRS was reported to be 1 (1-2). About 68.9% benefited from medical treatment and physiotherapy, whereas spinal surgical decompression was done in 22.8%. Seventy percent of the overall studies favor spinal surgical decompression, with the estimated average standardized mean difference between medical and surgical treatment being = 1.2083 (95% confidence interval: 1.0250-1.3917). Conclusion The T2DWI has moderate accuracy in detecting the T2HSI at the hyperacute time (NADIR <6 h). Even though surgical decompression favored good outcomes, medical treatment with physiotherapy was mostly used for the management of SCI.
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Affiliation(s)
- Yao Christian Hugues Dokponou
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
| | - Fresnel Lutèce Ontsi Obame
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
| | - Berjo Takoutsing
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Mubarak Jolayemi Mustapha
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
- Faculty of Basic Medical Science, University of Ilorin, Ilorin, Nigeria
| | - Arsène Daniel Nyalundja
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
- Department of Surgery, Catholic University, Bukavu, Democratic Republic of Congo
| | - Moussa Elmi Saad
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
| | - Omar Boladji Adebayo Badirou
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
| | - Dognon Kossi François de Paule Adjiou
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
| | - Nicaise Agada Kpègnon
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Abdou Moumouni University, Niamey, Niger
| | - Alngar Djimrabeye
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
| | - Nourou Dine Adeniran Bankole
- Department of Research, SubSaharan Africa Future Neurosurgeon Association, Cotonou, Bénin
- Department of Interventional Neuroradiology, Clinical Investigation Center, INSERM, Teaching Hospital of Tours, Tours, France
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Sedighi M, Tavakoli N, Taheri M, Basir Ghafouri H. Idiopathic cervical cord infarction in a young girl presenting with acute neck pain and flaccid paralysis: a case report. Spinal Cord Ser Cases 2024; 10:55. [PMID: 39097598 PMCID: PMC11297935 DOI: 10.1038/s41394-024-00659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Spinal cord infarction (SCI) is a rare disease representing nearly 1% of all strokes with a wide variety of symptoms at presentation. SCI diagnosis is very challenging owing to its low incidence and the variety of symptoms, and could be misdiagnosed with neuromyelitis optica spectrum disorders (NMOSD). CASE PRESENTATION We describe the case of an 18-year-old girl who presented to the emergency department with acute neck pain and flaccid paralysis of the left upper and lower extremities. Few hours later, she developed apnea and was endotracheally intubated. Brain MRI was normal but spinal cord MRI revealed non-enhancing longitudinal abnormal high T2 signal intensity extending from C1 to C5. The patient underwent steroid therapy with methylprednisolone (1 g daily for 7 consecutive days) combined with physiotherapy. She was extubated after 3 weeks and discharged after 30 days of hospitalization with a muscle force of 4/5 in her left extremities. DISCUSSION Idiopathic SCI in adolescence is a rare but often devastating disorder with unknown pathophysiology, however, some specific conditions in adolescent such as mechanical stresses on the immature spine can be considered as risk factors for SCI development. Early diagnosis and treatment can improve outcomes in SCI.
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Affiliation(s)
- Mohsen Sedighi
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Taheri
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Basir Ghafouri
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Althobaiti F, Maghrabi R, Alharbi N, Alwadai M, Almatrafi MK, Bajammal S. Anterior Spinal Artery Syndrome in a Patient With Multilevel Cervical Disc Disease: A Case Report. Cureus 2024; 16:e64577. [PMID: 39011315 PMCID: PMC11249051 DOI: 10.7759/cureus.64577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 07/17/2024] Open
Abstract
Anterior spinal artery syndrome (ASAS) is a rare form of spinal cord infarction, making its incidence and prevalence difficult to determine. We present the case of a 60-year-old woman with multiple vascular risk factors who experienced a sudden onset of severe lower limb weakness, raising immediate concerns about spinal cord ischemia. Diagnostic evaluations confirmed ASAS, although the exact cause and mechanism of her spinal cord infarction remained undetermined. The potential presence of significant cervical disc disease suggests fibrocartilaginous embolism (FCE) as a possible underlying mechanism, despite the lack of direct evidence. This case underscores the importance of clinical awareness and timely intervention in patients with similar symptoms and vascular risk factors. Early recognition, cause identification, and appropriate management are crucial for improving outcomes in spinal cord ischemia, guiding specific treatment strategies, and potentially preventing recurrence.
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Affiliation(s)
| | | | - Naif Alharbi
- Neurology, King Fahad General Hospital, Jeddah, SAU
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Kumawat C, Takahashi T, Date I, Tomita Y, Tanaka M, Arataki S, Komatsubara T, Flores AOP, Yu D, Jain M. State-of-the-Art and New Treatment Approaches for Spinal Cord Tumors. Cancers (Basel) 2024; 16:2360. [PMID: 39001422 PMCID: PMC11240441 DOI: 10.3390/cancers16132360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
Spinal cord tumors, though rare, present formidable challenges in clinical management due to their intricate nature. Traditional treatment modalities like surgery, radiation therapy, and chemotherapy have been the mainstay for managing these tumors. However, despite significant advancements, challenges persist, including the limitations of surgical resection and the potential side effects associated with radiation therapy. In response to these limitations, a wave of innovative approaches is reshaping the treatment landscape for spinal cord tumors. Advancements in gene therapy, immunotherapy, and targeted therapy are offering groundbreaking possibilities. Gene therapy holds the potential to modify the genes responsible for tumor growth, while immunotherapy harnesses the body's own immune system to fight cancer cells. Targeted therapy aims to strike a specific vulnerability within the tumor cells, offering a more precise and potentially less toxic approach. Additionally, novel surgical adjuncts are being explored to improve visualization and minimize damage to surrounding healthy tissue during tumor removal. These developments pave the way for a future of personalized medicine for spinal cord tumors. By delving deeper into the molecular makeup of individual tumors, doctors can tailor treatment strategies to target specific mutations and vulnerabilities. This personalized approach offers the potential for more effective interventions with fewer side effects, ultimately leading to improved patient outcomes and a better quality of life. This evolving landscape of spinal cord tumor management signifies the crucial integration of established and innovative strategies to create a brighter future for patients battling this complex condition.
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Affiliation(s)
- Chetan Kumawat
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
- Department of Orthopedic Surgery, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India
| | - Toshiyuki Takahashi
- Spinal Disorder Center, Fujieda Heisei Memorial Hospital, 123-1 Mizuue Fujieda, Shizuoka 426-8662, Japan
| | - Isao Date
- Department of Neurosurgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Yousuke Tomita
- Department of Neurosurgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Shinya Arataki
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Tadashi Komatsubara
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Angel O P Flores
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Dongwoo Yu
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Mukul Jain
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
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Ke G, Liao H, Chen W. Clinical manifestations and magnetic resonance imaging features of spinal cord infarction. J Neuroradiol 2024; 51:101158. [PMID: 37816441 DOI: 10.1016/j.neurad.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Spinal cord infarction (SCI) is a rare type of stroke, with no proposed classification or diagnostic criterium widely accepted and used in daily clinical practice currently. We try to explore the clinical manifestations and MRI features of SCI for improving the accurate diagnosis of SCI. METHODS Retrospectively analyzed the clinical data, MRI features, laboratory findings and outcomes of 40 patients who had been consecutively diagnosed with SCI in our hospital from June 2016 to January 2022. RESULTS Most of the SCI (92.5%) occurred at the level of T8-L2 and C4-T4. Transverse infarction (52.5%) and ASA territory infarction (27.5%) were the most common patterns. Longitudinally extensive lesions were noticed in 67.5% of the SCI and it might be a risk factor of poor prognosis (OR=21.11, 95%CI 2.14-208.29). Restricted diffusion of the SCI lesion occurred in 8h and a few lasted up to 60 days. All SCI showed spinal cord edema, accompanied by enhancement of the ventral cauda equina (13.8%), weakened enhancement of the dorsal venous plexus (44.8%), and vertebral infarction (25%). Most patients developed a stroke-like onset (92.5%) after movement (57.5%), with definite pain in the trunk or limbs (67.5%) and dissociative sensory disturbance (60.0%). The main etiologies of them include vascular abnormalities (45%) and iatrogenic injuries (15%). CONCLUSION An MRI classification of SCI based on the spinal cord blood supply was proposed. Restricted diffusion and co-existing abnormality of vertebral body and cauda equina may be the key neuroimaging feature for SCI diagnosis. Detailed history of vascular diseases or triggering factors are also helpful.
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Affiliation(s)
- Gaotan Ke
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiting Liao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Gharios M, Stenimahitis V, El-Hajj VG, Mahdi OA, Fletcher-Sandersjöö A, Jabbour P, Andersson M, Hultling C, Elmi-Terander A, Edström E. Spontaneous spinal cord infarction: a systematic review. BMJ Neurol Open 2024; 6:e000754. [PMID: 38818241 PMCID: PMC11138300 DOI: 10.1136/bmjno-2024-000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024] Open
Abstract
Background and objectives Spontaneous spinal cord infarction (SCInf) is a rare condition resulting in acute neurological impairment. Consensus on diagnostic criteria is lacking, which may present a challenge for the physician. This review aims to analyse the current literature on spontaneous SCInf, focusing on epidemiology, the diagnostic process, treatment strategies and neurological outcomes. Methods The study was performed in accordance with a previously published protocol. PubMed, Web of Science and Embase were searched using the keywords 'spontaneous', 'spinal cord', 'infarction' and 'ischaemic'. The eligibility of studies was evaluated in two steps by multiple reviewers. Data from eligible studies were extracted and systematically analysed. Results 440 patients from 33 studies were included in this systematic review. Analysis of vascular risk factors showed that hypertension was present in 40%, followed by smoking in 30%, dyslipidaemia in 29% and diabetes in 16%. The severity of symptoms at admission according to the American Spinal Injury Association (ASIA) Impairment Scale was score A 19%, score B14%, score C36% and score D32%. The mean follow-up period was 34.8 (±12.2) months. ASIA score at follow-up showed score A 11%, score B 3%, score C 16%, score D 67% and score E 2%. The overall mortality during the follow-up period was 5%. When used, MRI with diffusion-weighted imaging (DWI) supported the diagnosis in 81% of cases. At follow-up, 71% of the patients were able to walk with or without walking aids. Conclusion The findings suggest a significant role for vascular risk factors in the pathophysiology of spontaneous SCInf. In the diagnostic workup, the use of DWI along with an MRI may help in confirming the diagnosis. The findings at follow-up suggest that neurological recovery is to be expected, with the majority of patients regaining ambulation. This systematic review highlights gaps in the literature and underscores the necessity for further research to establish diagnostic criteria and treatment guidelines.
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Affiliation(s)
- Maria Gharios
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Vasilios Stenimahitis
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Rehabilitation, Furuhöjden Rehab Hospital, Täby, Sweden
| | | | - Omar Ali Mahdi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Magnus Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
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Safranek-Neylon H, Powers A, Rathore G. Acute Lower Extremity Weakness in a Pediatric Gymnast. Clin Pediatr (Phila) 2023; 62:1587-1590. [PMID: 36964681 DOI: 10.1177/00099228231162225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
| | - Andria Powers
- Children's Hospital & Medical Center, Omaha, NE, USA
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8
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Padilha IG, Fonseca APA, Amancio CT, Vieira APF, Pacheco FT, da Rocha AJ. Vascular Myelopathies. Semin Ultrasound CT MR 2023; 44:408-423. [PMID: 37690793 DOI: 10.1053/j.sult.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
There are many vascular disorders that can affect the spinal cord, and their prevalence and etiology are highly influenced by age, sex, and risk factors. This article reviews the embryology and anatomy of the spinal cord, as well as several vascular conditions, describing their clinical and imaging presentation, emphasizing the different imaging modalities' contributions to increasing specificity and better defining the most appropriate therapy strategy for improving the patient's prognosis.
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Affiliation(s)
- Igor Gomes Padilha
- Division of Neuroradiology, Diagnósticos da América SA-DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil; Division of Neuroradiology, Unitedhealth Group, São Paulo, SP, Brazil.
| | - Ana Paula Alves Fonseca
- Division of Neuroradiology, Diagnósticos da América SA-DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil; Division of Neuroradiology, Unitedhealth Group, São Paulo, SP, Brazil
| | - Camila Trolez Amancio
- Division of Neuroradiology, Diagnósticos da América SA-DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Hospital Sirio-Libanês, São Paulo, SP, Brazil
| | | | - Felipe Torres Pacheco
- Division of Neuroradiology, Diagnósticos da América SA-DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | - Antônio José da Rocha
- Division of Neuroradiology, Diagnósticos da América SA-DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
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A critical appraisal of clinical practice guidelines for diagnostic imaging in the spinal cord injury. Spine J 2023:S1529-9430(23)00107-9. [PMID: 36934792 DOI: 10.1016/j.spinee.2023.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/22/2023] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND CONTEXT Spinal cord injury (SCI) is a serious health problem which carries a heavy economic burden. Imaging technologies play an important role in the diagnosis of SCI. Although several organizations have developed guidelines for diagnostic imaging of SCI, their quality has not yet been systematically assessed. PURPOSE We aim to conduct a systematic review to appraise SCI guidelines and summarize their recommendations for diagnostic imaging of SCI. STUDY DESIGN Systematic review. METHODS We searched Embase, Medline, Web of Science, Cochrane, some guideline-specific databases (e.g., Scottish Intercollegiate Guidelines Network) and Google Scholar from January 2000 to January 2022. We included guidelines developed by nationally recognized organizations. If multiple versions could be obtained, we included the latest one. We appraised included guidelines using the AGREE II instrument which contains six domains (e.g., scope and purpose). We also extracted recommendations and assessed their supporting evidence using levels of evidence (LOE). The evidence was categorized as A (the best quality), B, C, and D (the worst quality). RESULTS Seven guidelines (2008 to 2020) were included. They all received the lowest scores in the domain of applicability. All guidelines (7/7, 100%) recommended magnetic resonance imaging (MRI) in patients with SCI or SCI without radiographic abnormality (SCIWORA). A total of 12 recommendations involving patient age (e.g., adult and child patients), timing of MRI (e.g., as soon as possible and in the acute period), symptoms indicated for MRI (e.g., a stiff spine and midline tenderness, suspected disc and posterior ligamentous complex injury, and neurological deficit), and types of MRI (e.g., T2-weighted imaging and diffusion tensor imaging) were extracted. Among them, the LOE was C in nine (75%) recommendations and D in three (25%) recommendations. CONCLUSIONS Seven guidelines were included in the present systematic review, and all of them showed the worst applicability scores in the AGREE II instrument. They all weakly recommended MRI for patients with suspected SCI or SCIWORA based on a low LOE.
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Mendel R, Tsirkin I, Soikher E, Haratz S. A Rare Case of Cardioembolic Spinal Stroke in a Young Female: Case Report. Case Rep Neurol 2023; 15:222-226. [PMID: 37901126 PMCID: PMC10601663 DOI: 10.1159/000531779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/22/2023] [Indexed: 10/31/2023] Open
Abstract
Spinal cord infarction (SCI) is a rare neurovascular disorder often presented with acute spinal cord syndrome. The diagnosis is generally made clinically, with appropriate neuroimaging to confirm the diagnosis and exclude other causes. We present an unusual case of a 48-year-old woman with no relevant past medical history, admitted with acute paraparesis and a spinal cord infarct on magnetic resonance imaging. A thorough investigation revealed asymptomatic unknown heart failure secondary to hypertrophic cardiomyopathy, suggestive of a cardioembolic etiology. The patient was treated with anticoagulation and improved significantly with physical rehabilitation.
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Affiliation(s)
- Rom Mendel
- Department of Neurology, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Irina Tsirkin
- Department of Neurology, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Eugene Soikher
- Department of Radiology, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Salo Haratz
- Department of Neurology, Assuta Ashdod Medical Center, Ashdod, Israel
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Acute Onset Quadriplegia and Stroke: Look at the Brainstem, Look at the Midline. J Clin Med 2022; 11:jcm11237205. [PMID: 36498778 PMCID: PMC9740674 DOI: 10.3390/jcm11237205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Acute onset quadriplegia with or without facial sparing is an extremely rare vascular syndrome, and the main focus of attention is on the cervical and upper thoracic spinal cord as the putative site of the damage. Quadriplegia has been occasionally reported in brainstem strokes within well-defined lesion patterns, but these reports have gained little attention so far because of the rarity of this clinical syndrome. The clinical, neuroanatomical and neuroimaging features of ischemic stroke locations associated with quadriplegia have been collected and reviewed in a pragmatical view, which includes a detailed description of the neurological signs associated with the damage of the pyramidal pathways. Two clinical examples have been added to raise practical suggestions in neurovascular practice. Ischemic stroke sites determining quadriplegia have some main well-defined midline locations in the brainstem, involving the pyramidal pathways of both sides in a single synchronous ischemic lesion in the medulla oblongata and in the pons. Several accompanying neurological signs have been described when the ischemic lesion involves tracts and nuclei other than the pyramidal pathways, and they can be useful as localizing clues. In some cases, the typical neuroimaging appearance of the ischemic lesion on Magnetic Resonance Imaging (MRI) has been reported as being a "heart appearance sign". This last sign has been described in midbrain strokes too, but this location is not associated with quadriplegia. The main etiology is atherothrombosis involving the intradural segment of the vertebral artery (VA) and their perforating branches. Two clinical examples of these rare vascular syndromes have been chosen to support a pragmatical discussion about the management of these cases. A midline ischemic stroke in the brainstem is a very rare vascular syndrome, and the acute onset quadriplegia is a distinctive feature of it. The awareness of this cerebrovascular manifestation might help to recognize and treat these patients.
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Kobayashi M. The utility of diffusion-weighted imaging in patients with spinal cord infarction: difference from the findings of neuromyelitis optica spectrum disorder. BMC Neurol 2022; 22:382. [PMID: 36221057 PMCID: PMC9552435 DOI: 10.1186/s12883-022-02903-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) plays a crucial role in diagnosing spinal cord infarction (SCI). However, the findings are often indistinguishable from those of other intramedullary diseases, such as neuromyelitis optica spectrum disorder (NMOSD). Although diffusion-weighted imaging (DWI) is a promising technique, the utility for discriminating SCI from NMOSD remains unclear because the DWI findings of acute NMOSD lesions have not been investigated in detail. Methods Clinical and MRI findings were retrospectively evaluated in 15 and 12 patients with acute SCI and NMOSD, respectively. First, clinical characteristics were compared between the SCI and NMOSD groups. Second, MRI abnormalities were examined to find differences between these groups. Third, in the SCI group, factors influencing T2 and DWI abnormalities were analyzed using the mixed-effects logistic regression analysis. Results The proportion of female patients was higher in the NMOSD group (92%) than in the SCI (40%). The time from symptom onset to nadir was smaller in the SCI group (median [interquartile range]; 4 [0.1–8.3] hours) than in the NMOSD (252 [162–576]). On T2-weighted images, SCI lesions had smaller length than NMOSD (2 [1–2] and 5 [2–7] vertebral segments, respectively). Focal lesions within the T9–L2 level were found only in patients with SCI. DWI hyperintensity was observed both in the SCI (frequency, 100%) and NMOSD (60%) groups. On apparent diffusion coefficient (ADC) maps, the hyperintensities of SCI had corresponding hypointensities, whereas those of NMOSD were isointense and a large portion of NMOSD lesions had hyperintense signals. Owl’s eyes sign and pencil-like hyperintensity, typically reported as T2 findings suggestive of SCI, were also found on DWI. Posterior linear hyperintensity was frequently detected on DWI in patients with posterior spinal artery infarction. The presence of MRI abnormality revealing SCI was modeled with the time from symptom onset, imaging sequence and plane, and affected vascular territory. Conclusions DWI and ADC maps help distinguish SCI from NMOSD. The time from symptom onset, imaging sequence, and imaging plane should be considered when MRI findings are interpreted in patients with suspected SCI.
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Affiliation(s)
- Makoto Kobayashi
- Department of Neurology, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan.
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13
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Features of non-traumatic spinal cord infarction on MRI: Changes over time. PLoS One 2022; 17:e0274821. [PMID: 36137128 PMCID: PMC9499193 DOI: 10.1371/journal.pone.0274821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Spinal cord infarction (SCI) is difficult to diagnosis using MRI findings. We aimed to suggest the optimal timing of MRI studies for diagnosing SCI. Materials and methods This retrospective study was approved by our institutional review board. The requirement for informed consent was waived. MRI scans of SCI patients diagnosed between January 2015 and August 2019 were enrolled in the SCI group and subdivided according to the interval between symptom onset and time of MRI scan (A, within 6 h; B, 6–12 hours; C, 12–24 hours; D, 24–72 hours; E, 3–7 days). Three radiologists analyzed the T2WI scans and evaluated the confidence level of diagnosing SCI using a five-point Likert scale: 1, certainly not; 2, probably not; 3, equivocal; 4, probably yes; 5, certainly yes. Scores of 4 and 5 were defined as “T2WI-positive SCI” and scores of 1–3 were defined as “T2WI-negative SCI”. Results The SCI group included 58 MRI scans of 34 patients (mean age, 60.6 ± 14.0 years; 18 women). The T2WI positivity rate was 72.4% (42/58). In contrast to the other subgroups, subgroup A included fewer cases of T2WI-positive SCI (1/4, 25%) than T2WI-negative SCI. A confidence score of 5 was the most common in subgroup D (4/27, 14.8%). Among the 12 patients who underwent MRI studies more than twice, confidence scores increased with time. Conclusion In patients with suspected SCI showing equivocal initial MRI findings, follow-up MRI studies are helpful, especially when performed between 24 and 72 hours after symptom onset.
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14
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Cuthbertson JD, Truong TK, Stormont R, Robb F, Song AW, Darnell D. An iPRES-W Coil Array for Simultaneous Imaging and Wireless Localized B 0 Shimming of the Cervical Spinal Cord. Magn Reson Med 2022; 88:1002-1014. [PMID: 35468243 PMCID: PMC10445458 DOI: 10.1002/mrm.29257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/13/2022] [Accepted: 03/11/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To develop a wireless integrated parallel reception, excitation, and shimming (iPRES-W) coil array for simultaneous imaging and wireless localized B0 shimming, and to demonstrate its ability to correct for distortions in DTI of the spinal cord in vivo. METHODS A 4-channel coil array was modified to allow an RF current at the Larmor frequency and a direct current to flow on each coil element, enabling imaging and localized B0 shimming, respectively. One coil element was further modified to allow additional RF currents within a wireless communication band to flow on it to wirelessly control the direct currents for shimming, which were supplied from a battery pack within the scanner bore. The RF signals for imaging were transferred via conventional wired connections. Experiments were conducted to evaluate the RF, B0 shimming, and wireless performance of this coil design. RESULTS The coil modifications did not degrade the SNR. Wireless localized B0 shimming with the iPRES-W coil array substantially reduced the B0 RMSE (-57.5% on average) and DTI distortions in the spinal cord. The antenna radiation efficiency, antenna gain pattern, and battery power consumption of an iPRES-W coil measured in an anechoic chamber were minimally impacted by the introduction of a saline phantom representing tissue. CONCLUSION The iPRES-W coil array can perform imaging and wireless localized B0 shimming of the spinal cord with no SNR degradation, with minimal change in wireless performance and without any scanner modifications or additional antenna systems within the scanner bore.
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Affiliation(s)
- Jonathan D. Cuthbertson
- Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
- Medical Physics Graduate Program, Duke University, Durham, North Carolina
| | - Trong-Kha Truong
- Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
- Medical Physics Graduate Program, Duke University, Durham, North Carolina
| | | | | | - Allen W. Song
- Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
- Medical Physics Graduate Program, Duke University, Durham, North Carolina
| | - Dean Darnell
- Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
- Medical Physics Graduate Program, Duke University, Durham, North Carolina
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15
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Thomas G, Alakbarzade V, Sammaraiee Y, Cociasu I, Dalton C, Pereira AC. Spontaneous spinal cord infarction: a practical approach. Pract Neurol 2022; 22:497-502. [PMID: 35835550 DOI: 10.1136/pn-2022-003441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/04/2022]
Abstract
Spontaneous spinal cord infarction is significantly less common than cerebrovascular disease. Because of the tight anatomical distribution of pathways in the cord, small spinal cord infarcts usually give more obvious symptoms and signs than similar lesions in the brain. Large epidemiological stroke studies have generally not included spinal cord stroke and so the incidence of vascular syndromes in the spinal cord is unknown. Management and prevention strategies for spontaneous spinal cord infarcts stem from small case series and case reports. Patient outcomes from spinal cord infarction are better with prompt recognition, timely management and prevention of associated medical complications arising from paraplegia, tetraplegia, neurogenic bladder and bowel dysfunction. The process of rehabilitation following spinal cord infarction is an evolving area.
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Affiliation(s)
- George Thomas
- Department of Older Persons' Medicine, James Cook University Hospital, Middlesbrough, UK
| | - Vafa Alakbarzade
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Yezen Sammaraiee
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ioana Cociasu
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Catherine Dalton
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Anthony C Pereira
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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16
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Focke JK, Seitz RJ. Reversal of Acute Spinal Cord Ischemia by Intravenous Thrombolysis. Neurol Clin Pract 2022; 11:e975-e976. [PMID: 34993001 DOI: 10.1212/cpj.0000000000001097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/05/2021] [Indexed: 11/15/2022]
Abstract
Acute non-traumatic ischemic myelopathy is a devastating condition with a typically poor outcome occurring in adults, adolescents and even children [1-3]. The acute onset of paraplegia and sensory loss are suggestive of spinal ischemia with little recovery potential [1, 4, 5]. Due to the lack of sufficient data there are no standardized guidelines regarding the acute treatment of spinal ischemia. While intravenous thrombolysis is a well established and effective treatment in cerebral ischemia, its efficacy in spinal cord ischemia has not yet been proven [5]. We report the case of a young female patient with acute spinal cord ischemia in whom treatment with systemic thrombolysis lead to a complete reversal of paraplegia.
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Affiliation(s)
- Jan K Focke
- Department of Neurology, LVR-Klinikum, Düsseldorf, Heinrich-Heine-University, Germany
| | - Rüdiger J Seitz
- Department of Neurology, LVR-Klinikum, Düsseldorf, Heinrich-Heine-University, Germany
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17
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Takayama H, Patel VI, Willey JZ. Stroke and Other Vascular Syndromes of the Spinal Cord. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Marcellino C, Zalewski NL, Rabinstein AA. Treatment of Vascular Myelopathies. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Fedaravičius A, Feinstein Y, Lazar I, Gidon M, Shelef I, Avraham E, Tamašauskas A, Melamed I. Successful management of spinal cord ischemia in a pediatric patient with fibrocartilaginous embolism: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21380. [PMID: 35855305 PMCID: PMC9265198 DOI: 10.3171/case21380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Fibrocartilaginous embolism (FCE) is a rare cause of ischemic myelopathy that occurs when the material of the nucleus pulposus migrates into vessels supplying the spinal cord. The authors presented a case of pediatric FCE that was successfully managed by adapting evidence-based recommendations used for spinal cord neuroprotection in aortic surgery. OBSERVATIONS A 7-year-old boy presented to the emergency department with acute quadriplegia and hemodynamic instability that quickly progressed to cardiac arrest. After stabilization, the patient regained consciousness but remained in a locked-in state with no spontaneous breathing. The patient presented a diagnostic challenge. Traumatic, inflammatory, infectious, and ischemic etiologies were considered. Eventually, the clinical and radiological findings led to the presumed diagnosis of FCE. Treatment with continuous cerebrospinal fluid drainage (CSFD), pulse steroids, and mean arterial pressure augmentation was applied, with subsequent considerable and consistent neurological improvement. LESSONS The authors proposed consideration of the adaptation of spinal cord neuroprotection principles used routinely in aortic surgery for the management of traumatic spinal cord ischemia (FCE-related in particular), namely, permissive arterial hypertension and CSFD. This is hypothesized to allow for the maintenance of sufficient spinal cord perfusion until adequate physiological blood perfusion is reestablished (remodeling of the collateral arterial network and/or clearing/absorption of the emboli).
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Affiliation(s)
- Augustinas Fedaravičius
- Department of Neurosurgery
- Department of Neurosurgery, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | | | - Ilan Shelef
- Department of Radiology, Soroka Medical Center, Be’er Sheva, Israel; and
| | | | - Arimantas Tamašauskas
- Department of Neurosurgery, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
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20
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Tan YJ, Manohararaj N. Isolated Infarctions of the Conus Medullaris: Clinical Features and Outcomes. J Stroke Cerebrovasc Dis 2021; 30:106055. [PMID: 34433121 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aims to describe the clinical features and outcomes of patients with isolated infarctions of the conus medullaris, and to identify factors associated with poor functional outcomes. MATERIALS AND METHODS We performed a systematic review and retrospective analysis on the clinical characteristics and outcomes of patients with isolated conus medullaris infarctions reported in literature over the past 30 years. RESULTS We analyzed a total of 19 cases; 18 identified in literature from January 1991 to June 2021, together with our patient. Their median age was 56 years (range 28-79), with twice as many females as males. Pain was prominent at onset (15/19, 79%), only a third had vascular risk factors (7/19, 37%), and half had no significant preceding activities or events (9/19, 47%). Almost all experienced paraplegia or paraparesis (16/19, 84%), in which upper motor neuron features were rare (3/19, 16%). The underlying cause was unknown in half (10/19, 53%). Functional outcomes appeared fair, with nearly half being capable of unassisted ambulation (9/11, 82%). Patients with vascular risk factors (67% vs 13%, p = 0.024) or with identified underlying causes (78% vs 13%, p = 0.007) were less likely to walk unassisted. CONCLUSION Isolated conus medullaris but should be considered in patients with acute cauda equina syndrome, especially in females. Patients with vascular risk factors, or with known causes of infarction, are less likely to walk unassisted. DWI sequences should be included in conventional MRI sequences when evaluating patients with acute cauda equina syndrome.
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Affiliation(s)
- You-Jiang Tan
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore.
| | - Nijanth Manohararaj
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
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21
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Yasuda N, Kuroda Y, Ito T, Sasaki M, Oka S, Ukai R, Nakanishi K, Mikami T, Shibata T, Harada R, Naraoka S, Kamada T, Kawaharada N. Postoperative spinal cord ischaemia: magnetic resonance imaging and clinical features. Eur J Cardiothorac Surg 2021; 60:164-174. [PMID: 33517384 DOI: 10.1093/ejcts/ezaa476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Ischaemic spinal cord injury (SCI) is one of the most serious complications of aortic surgery. Ischaemic SCIs occur due to various aetiologies, and prediction of the risk is difficult. Magnetic resonance imaging (MRI) is useful to detect the details of spinal cord infarction. There are few studies about MRI for evaluating ischaemic SCI after cardiovascular surgery and aortic events. We report 9 cases of postoperative ischaemic SCI and analyse their MRI features. METHODS T2-weighted MRI scans of 9 patients who developed ischaemic SCI due to cardiovascular surgery and aortic events between 2012 and 2017 were evaluated. RESULTS In all patients, high-intensity areas were observed on T2-weighted magnetic resonance images. The site of infarction was the thoracic spinal cord level (9 cases) and additionally at the lumbar spinal cord level (5 cases). The area of infarction area was categorized based on the arterial territory: anterior spinal artery territory (3 cases), posterior spinal artery territory (2 cases), spinal sulcal artery territory (1 case) and artery of Adamkiewicz territory (3 cases). CONCLUSIONS MRI revealed the infarction sites in all cases and the differences in the infarction patterns in each case. MRI could thus be useful for investigating the aetiology of ischaemic SCI following aortic surgeries and events.
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Affiliation(s)
- Naomi Yasuda
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan
| | - Toshiro Ito
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Masanori Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shinichi Oka
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryo Ukai
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Keitaro Nakanishi
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Kamada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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22
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McEntire CR, Dowd RS, Orru' E, David C, Small JE, Cervantes-Arslanian A, Lerner DP. Acute Myelopathy: Vascular and Infectious Diseases. Neurol Clin 2021; 39:489-512. [PMID: 33896530 DOI: 10.1016/j.ncl.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular and infectious causes are rare but important causes of spinal cord injury. High suspicion for these processes is necessary, as symptoms may progress over hours to days, resulting in delayed presentation and diagnosis and worse outcomes. History and clinical examination findings can assist with localization of the affected vascular territory and spinal level, which will assist with focusing spinal imaging. Open and/or endovascular surgical management depends on the associated vascular abnormality. Infectious myelopathy treatment consists of targeted antimicrobial therapy when possible, infectious source control, and again, close monitoring for systemic complications.
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Affiliation(s)
- Caleb R McEntire
- Department of Neurology, Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard S Dowd
- Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Emanuele Orru'
- Department of Radiology, Neurointerventional Radiology Division, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Carlos David
- Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA; Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Juan E Small
- Department of Radiology, Neuroradiology Section, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | | | - David P Lerner
- Division of Neurology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; Department of Neurology, Tufts University School of Medicine, Boston, MA 02111, USA.
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23
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Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients. NEUROLOGÍA (ENGLISH EDITION) 2021:S2173-5808(21)00077-8. [PMID: 34130946 DOI: 10.1016/j.nrleng.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. METHODS We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. RESULTS Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05). DISCUSSION Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.
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Abstract
Vascular disorders of the spinal cord are uncommon yet under-recognized causes of myelopathy. Etiologies can be predominantly categorized into clinical and radiographic presentations of arterial ischemia, venous congestion/ischemia, hematomyelia, and extraparenchymal hemorrhage. While vascular myelopathies often produce significant morbidity, recent advances in the understanding and recognition of these disorders should continue to expedite diagnosis and proper management, and ideally improve patient outcomes. This article comprehensively reviews relevant spinal cord vascular anatomy, clinical features, radiographic findings, treatment, and prognosis of vascular disorders of the spinal cord.
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25
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Agarwal V, Shah LM, Parsons MS, Boulter DJ, Cassidy RC, Hutchins TA, Jamlik-Omari Johnson, Kendi AT, Khan MA, Liebeskind DS, Moritani T, Ortiz AO, Reitman C, Shah VN, Snyder LA, Timpone VM, Corey AS. ACR Appropriateness Criteria® Myelopathy: 2021 Update. J Am Coll Radiol 2021; 18:S73-S82. [PMID: 33958120 DOI: 10.1016/j.jacr.2021.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 01/22/2023]
Abstract
Myelopathy is a clinical diagnosis with localization of the neurological findings to the spinal cord, rather than the brain or the peripheral nervous system, and then to a particular segment of the spinal cord. Myelopathy can be the result of primary intrinsic disorders of the spinal cord or from secondary conditions, which result in extrinsic compression of the spinal cord. While the causes of myelopathy may be multiple, the acuity of presentation and symptom onset frame a practical approach to the differential diagnosis. Imaging plays a crucial role in the evaluation of myelopathy with MRI the preferred modality. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Vikas Agarwal
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Vice Chair of Education, Department of Radiology, University of Pittsburgh Medical Center, Program Director, Neuroradiology Fellowship, University of Pittsburgh Medical Center.
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah, Chair, Committee on Appropriateness Criteria, Co-Chair, Neurological Imaging Panel, member of the ACR Commission on Neuroradiology
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky, American Academy of Orthopaedic Surgeons, Evidence Based Guideline Committee, North American Spine Society
| | | | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Director of Nuclear Medicine Therapies, Mayo Clinic Rochester
| | | | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California, American Academy of Neurology, President of SVIN
| | | | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina, North American Spine Society
| | - Vinil N Shah
- University of California San Francisco, San Francisco, California
| | - Laura A Snyder
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | - Vincent M Timpone
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Condette-Auliac S, Gratieux J, Boulin A, Di Maria F, Consoli A, Coskun O, Smajda S, Rodesch G. Imaging of vascular diseases of the spinal cord. Rev Neurol (Paris) 2021; 177:477-489. [PMID: 33902944 DOI: 10.1016/j.neurol.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Affiliation(s)
- S Condette-Auliac
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France.
| | - J Gratieux
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Boulin
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - F Di Maria
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - O Coskun
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - S Smajda
- Department of interventional Neuroradiology, Fondation Rotschild, Paris, France
| | - G Rodesch
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
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27
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Sulcal artery syndrome: A Three-patient series and review of literature. J Clin Neurosci 2021; 88:47-51. [PMID: 33992202 DOI: 10.1016/j.jocn.2021.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aims to describe the clinical characteristics of patients with sulcal artery syndrome, and between those with vertebral artery dissection against those without. METHODS We report three cases of sulcal artery syndrome without vertebral artery dissection, performed a systematic review and retrospective analysis of the characteristics of patients with sulcal artery syndrome in available literature, and compared the clinical features of those with vertebral artery dissection against those without. RESULTS We report 3 patients with sulcal artery syndrome, and analysed them with 17 other cases identified in literature between January 1990 till April 2020. The mean age was 47 years (range 10-80), with twice as many males as females. Pain at onset was a prominent feature (17/18, 94.4%). Preceding trauma occurred in less than half (7/18, 38.9%). Most had cervical cord infarctions (18/20, 90%), often over the high cervical cord (16/18, 88.9%). Good functional recovery (mRS 0-2) was observed in 86.7% (13/15). While vertebral artery dissection was the leading aetiology (11/20, 55.5%), about half of the cases were due to other causes. Cervical cord involvement was significantly associated with vertebral artery dissection (p = 0.026). CONCLUSION Sulcal artery syndrome should be suspected in patients with acute hemicord syndrome, especially in males with cervical cord involvement or pain at onset. High cervical cord involvement was strongly suggestive of underlying vertebral artery dissection. Additionally, DWI sequences are useful when evaluating acute myelopathies, and its inclusion in conventional MRI sequences is supported in prevailing literature.
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Cheng SJ, Tsai PH, Lee YT, Li YT, Chung HW, Chen CY. Diffusion Tensor Imaging of the Spinal Cord. Magn Reson Imaging Clin N Am 2021; 29:195-204. [PMID: 33902903 DOI: 10.1016/j.mric.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Spinal cord often is regarded as one of the last territories in the central nervous system where diffusion tensor imaging (DTI) can be used to probe white matter architecture. This article reviews current progress in spinal cord DTI, starting with anatomic properties and technical challenges that make spinal cord DTI a difficult task. Several possibilities offered by advanced pulse sequences that might overcome the difficulties are addressed, with associated trade-offs and limitations. Potential clinical assistance also is discussed in various spinal cord pathologies, such as myelopathy due to external compression, spinal cord tumors, acute ischemia, traumatic injury, and so forth.
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Affiliation(s)
- Sho-Jen Cheng
- Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan
| | - Ping-Huei Tsai
- Department of Medical Imaging and Radiological Sciences, Chung-Shan Medical University, No.110, Sec.1, Jianguo N. Road, Taichung 40201, Taiwan
| | - Yun-Ting Lee
- Translational Imaging Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan
| | - Yi-Tien Li
- Translational Imaging Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan
| | - Hsiao-Wen Chung
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, No.1, Sec.4, Roosevelt Road, Taipei 10617, Taiwan; Department of Electrical Engineering, National Taiwan University, No.1, Sec.4, Roosevelt Road, Taipei 10617, Taiwan.
| | - Cheng-Yu Chen
- Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan; Translational Imaging Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan
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Ros Castelló V, Sánchez Sánchez A, Natera Villalba E, Gómez López A, Parra P, Rodríguez Jorge F, Buisán Catevilla J, García Barragán N, Masjuan J, Corral I. Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients. Neurologia 2021; 38:S0213-4853(21)00002-5. [PMID: 33581950 DOI: 10.1016/j.nrl.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. METHODS We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. RESULTS Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P<.05). DISCUSSION Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.
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Affiliation(s)
- V Ros Castelló
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - A Sánchez Sánchez
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - E Natera Villalba
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Gómez López
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - P Parra
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F Rodríguez Jorge
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Buisán Catevilla
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - N García Barragán
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - I Corral
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
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Yun T, Lee KI, Koo Y, Kim H, Chang D, Lee C, Yang MP, Kang BT. Diffusion-Weighted Imaging Findings of Ischemic Spinal Injury in a Chondrodystrophic Dog With Fibrocartilaginous Embolism. Front Vet Sci 2020; 7:598792. [PMID: 33363237 PMCID: PMC7758316 DOI: 10.3389/fvets.2020.598792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/19/2020] [Indexed: 11/13/2022] Open
Abstract
A 9-year-old, intact male Shih Tzu dog presented with systemic weakness and peracute onset of tetraplegia. Tetraplegia with lower motor neuron signs was noted upon neurological examination. Diseases that cause acute flaccid tetraparesis, such as acute fulminating myasthenia gravis, polyradiculoneuritis, tick paralysis, and botulism, were ruled out based on the medical history, normal electrophysiological tests, and non-response to the neostigmine challenging test. Initial 0.3-Tesla (T) magnetic resonance imaging (MRI) findings included sharply demarcated intramedullary lesions at the C3-C6 level, mainly involving gray matter, which appeared hypo- to iso- intense on T1-weighted images (WIs), and hyperintense on T2-WIs and fluid-attenuated inversion recovery images. There was no enhancement on post-contrast T1-WIs. Neutrophilic pleocytosis was observed in the cerebrospinal fluid analysis. No clinical responses were observed for the treatment of non-infectious myelitis with an immunosuppressive dosage of prednisolone. A follow-up 3-T MRI 6 days later demonstrated hyperintensity on diffusion-WI (DWI) and a decreased apparent diffusion coefficient (ADC) value (0.54 × 10-3 mm2/s) of the spinal lesions. Through histological examination, a fibrocartilaginous embolism was definitively confirmed. This is the first report to describe an ischemic spinal injury visualized by DWI and ADC mapping with high-field MRI in a chondrodystrophic dog diagnosed with a fibrocartilaginous embolism.
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Affiliation(s)
- Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Kang-Il Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Dongwoo Chang
- Section of Veterinary Medical Imaging, Veterinary Teaching Hospital, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Chulhyun Lee
- Division of Convergence Biotechnology, Korea Basic Science Institute, Ochang, South Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
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Sepulveda F, Carballo L, Carnevale M, Yañez P. White cord syndrome in a pediatric patient: A case report and review. Radiol Case Rep 2020; 15:2343-2347. [PMID: 32994838 PMCID: PMC7501484 DOI: 10.1016/j.radcr.2020.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/27/2022] Open
Abstract
White cord syndrome is a rare condition involving sudden neurological deterioration following a decompressive cervical spinal surgery and characterized by the appearance of hyperintensity on T2-weighted magnetic resonance imaging. We present a report of a pediatric male patient who presented with the condition. This case shows that white cord syndrome can also be present in pediatric patients. We provide a brief review of the literature highlighting the main radiologic findings.
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Affiliation(s)
- Francisco Sepulveda
- Department of Neuroradiology, Instituto de Neurocirugía Dr. Asenjo, José Manuel Infante 553, Santiago, Providencia, Santiago, Chile
| | | | | | - Paulina Yañez
- Department of Radiology, FLENI, Buenos Aires, Argentina
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Konno M, Kanbayashi T, Hamada Y, Yamamoto J, Furukawa Y, Hatanaka Y, Sonoo M. [Hemiplegia cruciata and severe facial pain due to infarction of the cervicomedullary junction: a case report]. Rinsho Shinkeigaku 2020; 60:693-698. [PMID: 32893244 DOI: 10.5692/clinicalneurol.cn-001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report the case of a 66-year-old female with hemiplegia cruciata and severe facial pain due to infarction of the cervicomedullary junction. She presented to the hospital with complaints of acute-onset left facial pain and gait disturbance. Neurological examination revealed narrow left palpebral fissure, severe left facial pain and hypothermoesthesia, weakness predominantly in the left upper and right lower extremities, decreased pain and temperature sensation in the right lower extremity, decreased vibration sensation in the left lower extremity, hyperreflexia in the left upper extremity, and mild ataxia in the left upper and lower extremities. Brain MRI revealed a high-intensity lesion in the left cervicomedullary junction on diffusion-weighted and fluid-attenuated inversion recovery images. Hemiplegia cruciata due to the pyramidal tract injury at the cervicomedullary junction is an uncommon clinical manifestation. However, in patients with hemiplegia cruciata, identifying the lesion location may be difficult. Clinicians should consider the possibility of pyramidal decussation lesions. Anatomical differences, in the course of pyramidal tract fibers between the upper and lower limbs have been considered in the pyramidal decussation. Hemiplegia cruciata in this case was primarily caused by the impairment of the left upper limb pyramidal fibers after the pyramidal decussation and the right lower limb pyramidal fibers before the pyramidal decussation.
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Affiliation(s)
- Masahiro Konno
- Department of Neurology, Teikyo University School of Medicine
| | | | - Yuichi Hamada
- Department of Neurology, Teikyo University School of Medicine
| | - Junpei Yamamoto
- Department of Neurology, Teikyo University School of Medicine
| | - Yuichi Furukawa
- Department of Neurology, Teikyo University School of Medicine
| | - Yuki Hatanaka
- Department of Neurology, Teikyo University School of Medicine
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine
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Costamagna G, Meneri M, Abati E, Brusa R, Velardo D, Gagliardi D, Mauri E, Cinnante C, Bresolin N, Comi G, Corti S, Faravelli I. Hyperacute extensive spinal cord infarction and negative spine magnetic resonance imaging: a case report and review of the literature. Medicine (Baltimore) 2020; 99:e22900. [PMID: 33120840 PMCID: PMC7581089 DOI: 10.1097/md.0000000000022900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Spinal cord infarction (SCI) accounts for only 1% to 2% of all ischemic strokes and 5% to 8% of acute myelopathies. Magnetic resonance imaging (MRI) holds a role in ruling out non-ischemic etiologies, but the diagnostic accuracy of this procedure may be low in confirming the diagnosis, even when extensive cord lesions are present. Indeed, T2 changes on MRI can develop over hours to days, thus accounting for the low sensitivity in the hyperacute setting (ie, within 6 hours from symptom onset). For these reasons, SCI remains a clinical diagnosis. Despite extensive diagnostic work-up, up to 20% to 40% of SCI cases are classified as cryptogenic. Here, we describe a case of cryptogenic longitudinally extensive transverse myelopathy due to SCI, with negative MRI and diffusion-weighted imaging at 9 hours after symptom onset. PATIENT CONCERNS A 51-year-old woman presented to our Emergency Department with acute severe abdominal pain, nausea, vomiting, sudden-onset of bilateral leg weakness with diffuse sensory loss, and paresthesias on the trunk and legs. DIAGNOSES On neurological examination, she showed severe paraparesis and a D6 sensory level. A 3T spinal cord MRI with gadolinium performed at 9 hours after symptom onset did not detect spinal cord alterations. Due to the persistence of a clinical picture suggestive of an acute myelopathy, a 3T MRI of the spine was repeated after 72 hours showing a hyperintense "pencil-like" signal mainly involving the grey matter from T1 to T6 on T2 sequence, mildly hypointense on T1 and with restricted diffusion. INTERVENTIONS The patient was given salicylic acid (100 mg/d), prophylactic low-molecular-weight heparin, and began neuromotor rehabilitation. OUTCOMES Two months later, a follow-up neurological examination revealed a severe spastic paraparesis, no evident sensory level, and poor sphincteric control with distended bladder. LESSONS Regardless of its relatively low frequency in the general population, SCI should be suspected in every patient presenting with acute and progressive myelopathic symptoms, even in the absence of vascular risk factors. Thus, a clinical presentation consistent with a potential vascular syndrome involving the spinal cord overrides an initially negative MRI and should not delay timely and appropriate management.
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Affiliation(s)
- Gianluca Costamagna
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Megi Meneri
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Elena Abati
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Roberta Brusa
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Daniele Velardo
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Delia Gagliardi
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Eleonora Mauri
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Claudia Cinnante
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | - Nereo Bresolin
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Giacomo Comi
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Stefania Corti
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Irene Faravelli
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
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Stember DM, Hanson RM, Staudinger R. Spinal cord infarction in degenerative cervical spondylosis: An underdiagnosed phenomenon? Neurol Clin Pract 2020; 10:e33-e34. [PMID: 32983621 DOI: 10.1212/cpj.0000000000000743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/22/2019] [Indexed: 11/15/2022]
Affiliation(s)
| | - Richard M Hanson
- Department of Neurology, NYU School of Medicine and Veterans Affairs NYHHS
| | - Robert Staudinger
- Department of Neurology, NYU School of Medicine and Veterans Affairs NYHHS
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Mai W. Reduced field-of-view diffusion-weighted MRI can identify restricted diffusion in the spinal cord of dogs and cats with presumptive clinical and high-field MRI diagnosis of acute ischemic myelopathy. Vet Radiol Ultrasound 2020; 61:688-695. [PMID: 32931630 DOI: 10.1111/vru.12907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022] Open
Abstract
Diffusion-weighted imaging MRI is the gold standard imaging technique for diagnosis of suspected acute brain ischemia in dogs and cats; however, it is technically challenging to apply to spinal cord imaging, due to its very small size, the inherent low spatial resolution of diffusion-weighted imaging, and the marked distortion resulting from magnetic field inhomogeneities caused by the osseous components of the vertebral column surrounding the spinal cord. Ischemic myelopathy is a common cause of acute non-compressive myelopathy in dogs and cats. Technological improvement in diffusion-weighted imaging pulse sequences allow imaging at smaller field of view with better spatial resolution and less image distortion. We sought to evaluate reduced field-of-view diffusion-weighted imaging MRI using a dedicated proprietary pulse sequence (FOCUS, General Electric) in a small sample of dogs and cats with a presumptive clinical and MRI diagnosis of acute ischemic myelopathy that were imaged with this pulse sequence. Five dogs and two cats fitted these inclusion criteria. In all of them, hyperintense spinal cord parenchyma signal was seen on diffusion-weighted imaging images corresponding to decreased signal on apparent diffusion coefficient map indicative of restricted diffusion, consistent with ischemia and cytotoxic edema. These areas matched the areas of abnormal T2-weighted signal and cord swelling observed on conventional spinal MRI. This small exploratory descriptive study indicates feasibility and possible usefulness of reduced field-of-view diffusion-weighted imaging MRI in dogs and cats with suspected acute ischemic myelopathy and that it may be added to the imaging protocol of the spine in such patients in an appropriate clinical setting.
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Affiliation(s)
- Wilfried Mai
- Department of Clinical Sciences and Advanced Medicine, Section of Radiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
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Abstract
This article presents a comprehensive review of the evolution of both invasive and noninvasive imaging technologies that are part of the arsenal of spinal diagnostics and surgical therapy. The text provides not only a historical lens to the evolution of the imaging technologies that are part of routine contemporary practice but also provides a detailed sketch of emerging imaging technologies, such as endoscopic and exoscopic systems. Augmented reality, virtual reality, and mixed reality are new technologies that have enhanced the preparation of surgery and provide excellent case-specific training modules to break down each step of an operation in isolation.
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Fisher O, Benson RA, Wayte S, Kimani PK, Hutchinson C, Imray CHE. Multimodal analysis of the effects of dexamethasone on high-altitude cerebral oedema: protocol for a pilot study. Trials 2019; 20:604. [PMID: 31651350 PMCID: PMC6813976 DOI: 10.1186/s13063-019-3681-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/25/2019] [Indexed: 11/17/2022] Open
Abstract
Background Acute mountain sickness (AMS) is a cluster of symptoms that commonly occur in those ascending to high altitudes. Symptoms can include headaches, nausea, insomnia and fatigue. Exposure to high altitude can also lead to high-altitude cerebral oedema (HACE), which is a potential cause of death whilst mountaineering. Generally, AMS precedes the development of HACE. Historical studies have demonstrated the effectiveness of regular dexamethasone administration in reducing the symptoms of AMS. However, the mechanism by which dexamethasone works to reduce symptoms AMS remains poorly understood. Further studies, simulating altitude using hypoxic tents, have characterised the effect of prolonged exposure to normobaric hypoxia on cerebral oedema and blood flow using MRI. This randomised trial assesses the effect of dexamethasone on hypoxia-induced cerebral oedema in healthy adult volunteers. Methods/design D4H is a double-blind placebo-controlled randomised trial assessing the effect of dexamethasone on hypoxia-induced cerebral oedema. In total, 20 volunteers were randomised in pairs to receive either 8.25 mg dexamethasone or normal saline placebo intravenously after 8 h of hypoxia with an FiO2 of 12%. Serial MRI images of the brain and spinal cord were obtained at hours 0, 7, 11, 22 and 26 of the study along with serum and urinary markers to correlate with the severity of cerebral oedema and the effect of the intervention. Discussion MRI has been used to identify changes in cerebral vasculature in the development of AMS and HACE. Dexamethasone is effective at reducing the symptoms of AMS; however, the mechanism of this effect is unknown. If this study demonstrates a clear objective benefit of dexamethasone in this setting, future studies may be able to demonstrate that dexamethasone is an effective therapy for oedema associated with brain and spinal cord ischaemia beyond AMS. Trial registration Clinicaltrials.gov, NCT03341676. Registered on 14 November 2017.
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Affiliation(s)
- O Fisher
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK. .,University of Warwick, Coventry, UK.
| | - R A Benson
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.,University of Birmingham, Birmingham, UK
| | - S Wayte
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | | | - C Hutchinson
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.,University of Warwick, Coventry, UK
| | - C H E Imray
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.,University of Warwick, Coventry, UK
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Sarbu N, Lolli V, Smirniotopoulos JG. Magnetic resonance imaging in myelopathy: a pictorial review. Clin Imaging 2019; 57:56-68. [DOI: 10.1016/j.clinimag.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Prompt recognition and timely management of vascular disorders of the spinal cord can improve patient outcomes. This article provides contemporary and practical knowledge about the most common vascular myelopathies. RECENT FINDINGS New studies have provided additional information on the risk factors and impact of neurologic monitoring on perioperative spinal cord infarction. Additionally, recent publications have provided information on the impact of misdiagnosis, corticosteroid treatment, and postoperative prognosis in the treatment of spinal dural arteriovenous fistulas and have discussed the outcome of patients with spinal arteriovenous malformations treated with embolization, surgery, and stereotactic radiosurgery. Finally, recent studies have provided information on the natural history and postoperative prognosis of spinal cavernous malformations and on the risk factors and surgical outcome of patients with spinal epidural hematomas. SUMMARY Diagnostic and therapeutic challenges are inherent in managing patients with vascular disorders of the spinal cord, and clinicians should have a thorough understanding of these disorders to facilitate optimal outcomes for patients with these potentially devastating illnesses. This article begins by reviewing functional vascular anatomy and subsequently describes the fundamental characteristics of both ischemic and hemorrhagic vascular myelopathies to equip clinicians with the knowledge to avoid common pitfalls.
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Yadav N, Pendharkar H, Kulkarni GB. Spinal Cord Infarction: Clinical and Radiological Features. J Stroke Cerebrovasc Dis 2018; 27:2810-2821. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/07/2018] [Accepted: 06/08/2018] [Indexed: 11/25/2022] Open
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Clinical applications of diffusion weighted imaging in neuroradiology. Insights Imaging 2018; 9:535-547. [PMID: 29846907 PMCID: PMC6108979 DOI: 10.1007/s13244-018-0624-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/12/2018] [Accepted: 03/20/2018] [Indexed: 12/21/2022] Open
Abstract
Abstract Diffusion-weighted imaging (DWI) has revolutionised stroke imaging since its introduction in the mid-1980s, and it has also become a pillar of current neuroimaging. Diffusion abnormalities represent alterations in the random movement of water molecules in tissues, revealing their microarchitecture, and occur in many neurological conditions. DWI provides useful information, increasing the sensitivity of MRI as a diagnostic tool, narrowing the differential diagnosis, providing prognostic information, aiding in treatment planning and evaluating response to treatment. Recently, there have been several technical improvements in DWI, leading to reduced acquisition time and artefacts and enabling the development of diffusion tensor imaging (DTI) as a tool for assessing white matter. We aim to review the main clinical uses of DWI, focusing on the physiological mechanisms that lead to diffusion abnormalities. Common pitfalls will also be addressed. Teaching Points • DWI includes EPI, TSE, RESOLVE or EPI combined with reduced volume excitation. • DWI is the most sensitive sequence in stroke diagnosis and provides information about prognosis. • DWI helps in the detection of intramural haematomas (arterial dissection). • In diffusion imaging, ADC is inversely proportional to tumour cellularity. • DWI and DTI derived parameters can be used as biomarkers in different pathologies.
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Schatlo B, Remonda L, Gruber P, Fandino J, Rohde V, Fathi AR, Berberat J. Cervical Spine Prospective Feasibility Study : Dynamic Flexion-Extension Diffusion-Tensor Weighted Magnetic Resonance Imaging. Clin Neuroradiol 2018; 29:523-532. [PMID: 29671001 DOI: 10.1007/s00062-018-0686-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/30/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Diffusion tensor imaging (DTI) in flexion-extension may serve as a diagnostic tool to improve the sensitivity for detection of myelopathy. In this study, the feasibility and reproducibility of dynamic DTI in the cervical spinal cord was assessed in healthy volunteers and patients. METHODS All subjects were examined in maximum neck flexion-extension in a 3T magnetic resonance imaging (MRI) scanner. Range of motion, space available for the spinal cord, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured and compared between the neck positions. RESULTS Volunteers showed no variation in ADC and FA. In patients, extension produced higher ADC in the diseased than in the control segments (p = 0.0045). The ADC of the affected segments was higher in extension than in the neutral position (p = 0.0030) or in flexion (p = 0.0002). The FA was significantly lower in extension in patients at both the control level C2/3 (p = 0.0154) and the affected segment (p = 0.0187). CONCLUSIONS Dynamic DTI of the cervical spine is feasible and ADC increased in the patient group in extension. This finding may open a previously unexplored avenue to attempt an earlier identification of myelopathy.
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Affiliation(s)
- Bawarjan Schatlo
- Department of Neuroradiology, Cantonal Hospital Aarau, Tellstraße 25, 5001, Aarau, Switzerland.,Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland.,Department of Neurosurgery, University Medicine Göttingen, Georg-August University, Göttingen, Germany
| | - Luca Remonda
- Department of Neuroradiology, Cantonal Hospital Aarau, Tellstraße 25, 5001, Aarau, Switzerland
| | - Philipp Gruber
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Veit Rohde
- Department of Neurosurgery, University Medicine Göttingen, Georg-August University, Göttingen, Germany
| | - Ali-Reza Fathi
- Department of Neurosurgery, Hirslanden Clinik, Aarau, Switzerland
| | - Jatta Berberat
- Department of Neuroradiology, Cantonal Hospital Aarau, Tellstraße 25, 5001, Aarau, Switzerland.
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43
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Bar C, Cheuret E, Bessou P, Pedespan JM. Childhood idiopathic spinal cord infarction: Description of 7 cases and review of the literature. Brain Dev 2017; 39:818-827. [PMID: 28578817 DOI: 10.1016/j.braindev.2017.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/11/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe the clinical course, neuroimaging findings and functional outcome of idiopathic spinal cord infarction (SCI) in adolescents. METHODS Retrospective and descriptive analyses of seven patients with idiopathic SCI and 50 additional cases from the literature were included. Data collected concerned clinical presentation, MRI findings, initial diagnosis, treatments and functional outcome at the last medical visit. RESULTS Mean age at presentation was 13.2years (range 13-15). All patients presented a sudden and painful acute myelopathy with <24h time to maximal symptoms manifestation. A suspected trigger related to a minor effort was reported in 3/7 cases. Six patients presented with paraplegia, one with paraparesis. All had bladder dysfunction needing catheterization. Three patients had an initial misdiagnosis. Initial MRI was considered as normal in 2 cases. In the 5 other cases, T2-weighted-MR images showed hyperintensity within the thoracolumbar spinal cord, affecting mostly the anterior spinal artery territory. Evidence for associated spinal growth dystrophy were present in 6/7 cases. Mean follow-up time was 27.4months (range 3-46): 2 patients recovered autonomous ambulation, 4 patients regained walking ability with aids and one child (the shortest follow-up) remained wheelchair-dependent. A neurogenic bladder was still reported in 6/7 children at the last visit. Complementary analyses with literature cases were consistent with the findings obtained in our cohort. CONCLUSION Idiopathic SCI typically occurs in adolescence with a rapid onset and painful acute myelopathy. The MRI shows a T2-hyperintense signal within the spinal cord and provides evidence for an ischemic mechanism. Etiology remains unclear in most cases even though some specific risk factors for this age must play an important role in the pathogenesis, such as mechanical constraints on the immature spine.
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Affiliation(s)
- Claire Bar
- Service de Neurologie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
| | - Emmanuel Cheuret
- Service de Neurologie Pédiatrique, Hôpital des Enfants, CHU de Toulouse, France
| | - Pierre Bessou
- Service d'imagerie anténatale, de l'enfant et de la femme, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Jean-Michel Pedespan
- Service de Neurologie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
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Yamamoto N, Miyagi R, Sakai T, Morimoto K, Henmi T, Sairyo K. Magnetic resonance imaging and diffusion-weighted imaging findings in posterior spinal cord infarction: Case report. J Orthop Sci 2017; 22:1151-1154. [PMID: 27183891 DOI: 10.1016/j.jos.2016.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/05/2016] [Accepted: 04/09/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Ryo Miyagi
- Department of Orthopedics, Institute of Health Biosciences, Tokushima University Graduate School, Tokushima, Japan.
| | - Toshinori Sakai
- Department of Orthopedics, Institute of Health Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kuniaki Morimoto
- Department of Orthopedic Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Tatsuhiko Henmi
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Health Biosciences, Tokushima University Graduate School, Tokushima, Japan
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45
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Guan L, Chen X, Hai Y, Ma X, He L, Wang G, Yuan C, Guo H. High-resolution diffusion tensor imaging in cervical spondylotic myelopathy: a preliminary follow-up study. NMR IN BIOMEDICINE 2017; 30:e3769. [PMID: 28703331 DOI: 10.1002/nbm.3769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 06/07/2023]
Abstract
Diffusion imaging is a promising technique as it can provide microstructural tissue information and thus potentially show viable changes in spinal cord. However, the traditional single-shot imaging method is limited as a result of various image artifacts. In order to improve measurement accuracy, we used a newly developed, multi-shot, high-resolution, diffusion tensor imaging (DTI) method to investigate diffusion metric changes and compare them with T2 -weighted (T2W) images before and after decompressive surgery for cervical spondylotic myelopathy (CSM). T2W imaging, single-shot DTI and multi-shot DTI were employed to scan seven patients with CSM before and 3 months after decompressive surgery. High signal intensities were scored using the T2 W images. DTI metrics, including fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD), were quantified and compared pre- and post-surgery. In addition, the relationship between imaging metrics and neurological assessments was examined. The reproducibility of multi-shot DTI was also assessed in 10 healthy volunteers. Post-surgery, the mean grade of cervical canal stenosis was reduced from grade 3 to normal after 3 months. Compared with single-shot DTI, multi-shot DTI provided better images with lower artifact levels, especially following surgery, as a result of reduced artifacts from metal implants. The new method also showed acceptable reproducibility. Both FA and RD values from the new acquisition showed significant differences post-surgery (FA, p = 0.026; RD, p = 0.048). These changes were consistent with neurological assessments. In contrast, T2W images did not show significant changes before and after surgery. Multi-shot diffusion imaging showed improved image quality over single-shot DWI, and presented superior performance in diagnosis and recovery monitoring for patients with CSM compared with T2W imaging. DTI metrics can reflect the pathological conditions of spondylotic spinal cord quantitatively and may serve as a sensitive biomarker for potential CSM management.
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Affiliation(s)
- Li Guan
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Chen
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaodong Ma
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Guangzhi Wang
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
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46
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Rutman AM, Peterson DJ, Cohen WA, Mossa-Basha M. Diffusion Tensor Imaging of the Spinal Cord: Clinical Value, Investigational Applications, and Technical Limitations. Curr Probl Diagn Radiol 2017; 47:257-269. [PMID: 28869104 DOI: 10.1067/j.cpradiol.2017.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022]
Abstract
Although diffusion-weighted imaging (DWI) has become a mainstay in modern brain imaging, it remains less utilized in the evaluation of the spinal cord. Many studies have shown promise in using DWI and diffusion-tensor imaging (DTI) for evaluation of the spinal cord; however, application has been stalled by technical obstacles and artifacts, and questions remain regarding its clinical utility on an individual examination level. This review discusses the background, concepts, and technical aspects of DWI and DTI, specifically for imaging of the spinal cord. The clinical and investigational applications of spinal cord DTI, as well as the practical difficulties and limitations of DWI and DTI for the evaluation of the spinal cord are examined.
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Affiliation(s)
- Aaron M Rutman
- Department of Radiology, University of Washington, Seattle, WA.
| | | | - Wendy A Cohen
- Department of Radiology, University of Washington, Seattle, WA
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47
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Rossi A, Martinetti C, Morana G, Severino M, Tortora D. Diagnostic Approach to Pediatric Spine Disorders. Magn Reson Imaging Clin N Am 2017; 24:621-44. [PMID: 27417404 DOI: 10.1016/j.mric.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Understanding the developmental features of the pediatric spine and spinal cord, including embryologic steps and subsequent growth of the osteocartilaginous spine and contents is necessary for interpretation of the pathologic events that may affect the pediatric spine. MR imaging plays a crucial role in the diagnostic evaluation of patients suspected of harboring spinal abnormalities, whereas computed tomography and ultrasonography play a more limited, complementary role. This article discusses the embryologic and developmental anatomy features of the spine and spinal cord, together with some technical points and pitfalls, and the most common indications for pediatric spinal MR imaging.
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Affiliation(s)
- Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy.
| | - Carola Martinetti
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Mariasavina Severino
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Domenico Tortora
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
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48
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Magnetic Resonance Imaging and Clinical Features in Acute and Subacute Myelopathies. Clin Neuroradiol 2017; 27:417-433. [PMID: 28667382 DOI: 10.1007/s00062-017-0604-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
Differential diagnosis of acute and subacute transverse myelopathy includes inflammatory, infectious, vascular, metabolic and paraneoplastic etiologies. Information on the diagnostic approach to transverse myelopathy with regard to daily clinical practice is provided. The differentiation between five lesion patterns on magnetic resonance imaging (MRI) in myelitis may be helpful: (1) longitudinal extensive transverse myelitis, (2) short segment ovoid or peripherally located, (3) "polio-like", (4) granulomatous and (5) segmental with rash. A correlation with these imaging features is supported if the clinical course and neurological symptoms are known. Although the mean interval from onset to nadir of symptoms in spinal cord infarction is 1 h, an overlap with a fulminant course of myelitis is possible, and impaired diffusion may also occur in acute inflammatory processes. As a result, laboratory testing, including aquaporin-4 antibodies and cerebrospinal fluid analysis, is crucial for the correct interpretation of imaging findings. Moreover, the discrimination of acute complete and acute partial transverse myelitis is advantageous in order to identify diverse entities, the latter often being a precursor to multiple sclerosis. Additional brain imaging is mandatory in suspected demyelinating, infectious, neoplastic and systemic autoimmune disease. A symmetrical lesion pattern restricted to individual tracts or dorsal columns indicates subacute combined degeneration of the spinal cord and, in addition to deficiency syndromes, a paraneoplastic etiology should be considered.
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49
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Spinal Cord Infarction in the Course of a Septic Shock: About One Case and Review of the Literature. Case Rep Crit Care 2017; 2017:1571048. [PMID: 28316845 PMCID: PMC5337840 DOI: 10.1155/2017/1571048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/24/2017] [Indexed: 12/29/2022] Open
Abstract
We report the case of a patient admitted to our intensive care unit in the course of a septic shock, secondary to cholangitis. After rapid hemodynamic stabilization, antibiotherapy, and endoscopic extraction of bile ducts stones, she appeared to have developed flaccid paraplegia. The suspected diagnosis of medullar ischemia was confirmed by typical MRI findings. This case stresses the potential pathogenic role of hypotension in medullar ischemia and the place of magnetic resonance imaging (MRI) as a reliable diagnostic tool.
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50
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Artemis D, Wolf M, Blahak C, Szabo K, Hennerici MG, Fatar M. Diagnostic and Prognostic Relevance of Magnetic Resonance Imaging and Electrophysiological Findings in Acute Spinal Ischemia. J Stroke Cerebrovasc Dis 2017; 26:459-464. [PMID: 28089563 DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/27/2016] [Accepted: 12/26/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Our purpose was to classify the rare entity of spontaneous spinal ischemia with clinical, magnetic resonance-tomographic, and electrophysiological parameters to determine criteria for outcome prediction. METHODS We analyzed the stroke registry database of the University Hospital Mannheim, Germany, from 2004 to 2010 for patients with a diagnosis of vascular spinal cord ischemia. RESULTS Ten patients were identified (mean age 65 years [range 50-83], 5 women). In 5 patients an etiology was found. Spinal diffusion-weighted magnetic resonance imaging revealed acute ischemia in 7 patients at initial imaging and this diagnosis was confirmed during the first week in the remaining 3 patients. Electrophysiological studies showed abnormal motor evoked potentials (MEPs) in 8 patients and abnormal somatosensory evoked potentials (SSEPs) in 7 patients. After rehabilitation, 5 patients had regained walking ability, whereas 5 patients stayed wheelchair bound. All patients with unfavorable outcome (American Spinal Injury Association (ASIA) Impairment score [AIS] score of ≤C) showed severe pyramidal tract lesions in MEPs during the first week. All patients with normal MEPs had an excellent outcome (AIS of E, P < .05). CONCLUSIONS Diffusion-weighted imaging (DWI) is a useful tool to confirm acute spinal ischemia suspected in patients within the first days after symptom onset. Poor outcome was associated with severe electrophysiological abnormalities in MEPs and SSEPs. Normal MEPs were significantly predictive of an excellent prognosis. A multimodal diagnostic approach combining DWI and electrophysiological evaluation facilitates the prediction of the individual clinical outcome.
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Affiliation(s)
- Dimitrios Artemis
- Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany.
| | - Marc Wolf
- Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Christian Blahak
- Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Kristina Szabo
- Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Michael G Hennerici
- Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Marc Fatar
- Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
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