PMC6435483_01
(A) T2-weighted sagittal admission MRI image of the cervical spine showing longitudinally extensive, non-enhancing, mildly expansile hyperintensity within the central gray matter of the spinal cord spanning levels C2-T2 with normal appearance of the vertebral flow voids. Mild intervertebral disc intensity changes are observable at C2-C6. (B,C) Axial T2-weighted MRI images at levels C6 and C8 respectively demonstrating localization of T2-hyperintensity to the anterior horns with an "owl's eye" appearance. (D) Diffusion-weighted imaging demonstrating diffusion restriction within the cervical cord lining up with the T2-hyperintense lesion. (E) Diagnostic angiogram showing the cervical view of the left vertebral artery catheterization. Brisk and robust collateralization to the vascular supply of the spinal cord, including the anterior spinal artery, and spinal canal is seen. There is no evidence of infarction or dissection of the spinal vasculature.
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F1
T2-hyperintense central cord lesion strictly involving the gray matter from C2-T2 with mild edema, intervertebral disc intensity changes in the cervical levels (Figures 1A-C) and robust diffusion restriction (Figure 1D). These findings were initially thought to be suggestive of spinal cord infarct, although no abnormal flow void, cord compression, mass lesion, discrete disc herniation or desiccation, or other spinal or foraminal stenosis was noted. On HD 3, interventional angiogram showed brisk, robust filling and collateralization of the vascular supply of the spinal cord, and canal after left vertebral artery injection (Figure 1E).