PMC8769399_01
MRI-DWI taken immediately after arrival. Patchy high signals are seen in the left cerebellar hemisphere (arrow). DWI: diffusion-weighted imaging, MRI: magnetic resonance imaging.
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Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) taken just after arrival revealed patchy signal hyperintensities in the left cerebellar hemisphere on diffusion-weighted imaging (DWI) and intracranial carotid stenosis in the right C3 and left C2 portions (Fig. 1).
MRA taken simultaneously with DWI (Fig. 1). (A) Intracranial MRA. Carotid stenosis is seen in the right C3 and left C2 portion. (B) Neck MRA. (C-F) MRA original images are at the V4 portion, V3 portion, V2 portion at the level of the C3 vertebral body, and V2 portion at the level of the C4 vertebral body, respectively. Dissection of VA is ruled out. MRA: magnetic resonance angiography, MRI: magnetic resonance imaging, VA: vertebral artery.
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Vertebral artery dissection was ruled out as the cause of the neck pain (Fig. 2).
Repeated MRI and MRA, taken at the time hemiparesis developed. (A) DWI; (B) Intracranial MRA. The finding is the same as in Fig. 1, and no new lesion is evident. DWI: diffusion-weighted imaging, MRA: magnetic resonance angiography, MRI: magnetic resonance imaging.
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Repeated MRI and MRA revealed only the lesion previously described, with no new lesions (Fig. 3).
Cervical MRI at the time of deterioration to tetraplegia. (A) Sagittal view. A lesion appearing hyperintense on T2-weighted imaging and isointense on T1-weighted imaging is apparent in the posterior epidural space (arrow). (B) Axial view. MRI: magnetic resonance imaging.
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C2-Th2 level, lateralized to the right side (Fig. 4). Cervical SSEH was finally diagnosed.
Plain CT taken before administration of rt-PA, after the development of hemiparesis. (A) Axial section at the C6 level. (B) Same image, indicating the position of the hyperdense area, representing epidural hematoma, by a dotted area. The hematoma is lateralized to the right side. CT: computed tomography, rt-PA: recombinant tissue plasminogen activator.
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The chest CT taken before the administration of rt-PA was reviewed, and a high-density lesion suggestive of hematoma was recognized in the spinal canal (Fig. 5).