PMC6744722_01
Pre-operative lumbar MRI showing a right paracentral disc herniation at L4-L5 causing nerve root compression (arrow). Notice the patient's significant bladder distension (*).
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F1
The lumbar magnetic resonance imaging (MRI) demonstrated an acute right L4-L5 paracentral disc herniation contributing to the canal and right lateral recess stenosis [Figure 1].
Sagittal T2 image of the post operative lumbar MRI showing the conus medullaris is expanded and there is new subtle increased signal. This is remote from the area of the surgery (arrow).
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F2
The emergent postoperative lumbar MR showed a subtle increased T2 signal at the L1-L2 level involving the conus medullaris; autoimmune, inflammatory, and hypercoagulation workups proved negative, but the remaining differential diagnoses included ischemia versus posttraumatic/inflammatory changes [Figure 2].
Sagittal views from late post operative lumbar MRI (2 weeks post surgery). T2 (left), STIR (right) showing hemorrhagic conversion in the conus medullaris with cavitation from the hemorrhage (arrow).
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F3
Several weeks later, the follow-up MRI revealed a low T2 signal within the conus, consistent with/ suggestive of hemorrhage [Figure 3].