PMC4010056_01
MRI thoracic spine showing acute spinal cord infarction. Sagittal T2-weighted MRI of the patient's thoracic spine demonstrating nonspecific central intrinsic signal hyperintensity of the spinal cord located in conus region with extension to T8 level. Multilevel thoracic disc disease at T1 and T10-T11 is also present.
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fig1
T2-weighted magnetic resonance image (MRI) showed a nonspecific central intrinsic signal hyperintensity in the conus region extending to the level of T8, concerning for acute spinal cord ischemia (Figures 1 and 2). Transthoracic echocardiogram, performed to determine if there was a cardiac source of emboli, showed atypical dyskinesia with left ventricular apical ballooning and an ejection fraction of 35%, a characteristic of neurogenic stunned myocardium (Figures 3 and 4).
MRI of the lumbar spine showing acute spinal cord infarction. Sagittal T2-weighted MRI of the patient's lumbar spine showing a nonspecific central intrinsic signal hyperintensity of the spinal cord located in conus region with extension to T8 level. Image also shows multilevel degenerative disc disease with noncompressive disc herniation at L1-L2.
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fig2
T2-weighted magnetic resonance image (MRI) showed a nonspecific central intrinsic signal hyperintensity in the conus region extending to the level of T8, concerning for acute spinal cord ischemia (Figures 1 and 2). Transthoracic echocardiogram, performed to determine if there was a cardiac source of emboli, showed atypical dyskinesia with left ventricular apical ballooning and an ejection fraction of 35%, a characteristic of neurogenic stunned myocardium (Figures 3 and 4).
Transthoracic echocardiogram. The patient's apical four-chamber transthoracic echocardiogram at end systole showing left ventricle, left atrium, and mitral valve. There is left ventricular basilar contraction (small arrow), with near apposition of the endomyocardium, and severe apical hypokinesia (large arrow) with apical ballooning.
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PMC4010056_01_CRIM.CRITICAL.CARE2012-439528.003.jpg
fig3
T2-weighted magnetic resonance image (MRI) showed a nonspecific central intrinsic signal hyperintensity in the conus region extending to the level of T8, concerning for acute spinal cord ischemia (Figures 1 and 2). Transthoracic echocardiogram, performed to determine if there was a cardiac source of emboli, showed atypical dyskinesia with left ventricular apical ballooning and an ejection fraction of 35%, a characteristic of neurogenic stunned myocardium (Figures 3 and 4).
Transthoracic echocardiogram. The patient's transthoracic echocardiogram in diastole showing neurogenic stunned myocardium. Apical four-chamber view showing left ventricle, left atrium, and mitral valve during diastole. Note the uniformity of the endomyocardium resulting in a "bullet shape" of the left ventricle in which all three segments of the ventricle: base, mid, and apex relax equally.
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PMC4010056_01_CRIM.CRITICAL.CARE2012-439528.004.jpg
fig4
T2-weighted magnetic resonance image (MRI) showed a nonspecific central intrinsic signal hyperintensity in the conus region extending to the level of T8, concerning for acute spinal cord ischemia (Figures 1 and 2). Transthoracic echocardiogram, performed to determine if there was a cardiac source of emboli, showed atypical dyskinesia with left ventricular apical ballooning and an ejection fraction of 35%, a characteristic of neurogenic stunned myocardium (Figures 3 and 4).