PMC5646312_01
Lumbar spine MR work-up at admission. (a) Midsagittal contrast-enhanced (CE) T1-weighted view with Fat Suppression (FS) option. Spondylodiscitis at L4-L5 level (arrow) with necroticocystic intersomatic abscess and strong enhancement of the adjacent bone marrow. Epidural abscess extending from T11/T12 to S1/S2 was well seen (asterisk) together with intense enhancement of the dura (arrows). (b) Axial-transverse CE T1-weighted view through the L1 level. Anterior epidural abscess is well seen (asterisk) impinging on posteriorly displaced thecal sac. Note intense enhancement of the dura (arrow).
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The initial magnetic resonance imaging (MRI) (Figure 1(a)) demonstrated a necroticocystic lumbar spondylodiscitis complicated by huge epidural abscess with diffuse inflammation of adjacent meninges. A follow-up spinal cord MRI (Figure 1(b)) revealed the onset of a spinal cord infarction from C7 to T6 in the upper territory of the anterior spinal artery featured by a sharply delineated hypersignal intensity within involved areas on T2-weighted images (Figure 2).
Follow-up MR examination of the cervicodorsal segments. (a) Midsagittal CE T1-weighted view showing strong enhancement of both dura and pia (between arrows) surrounding spinal cord. (b) Midsagittal T2-weighted view showing relative hypersignal intensity within upper anterior spinal artery territory between T1/T2 and T5/T6 disks (arrows) corresponding to spinal cord infarction.
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A follow-up spinal cord MRI (Figure 1(b)) revealed the onset of a spinal cord infarction from C7 to T6 in the upper territory of the anterior spinal artery featured by a sharply delineated hypersignal intensity within involved areas on T2-weighted images (Figure 2).
Core temperature recorded from a central venous catheter twice a day (4:00 and 18:00), before and after the introduction of oral progesterone.
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In an attempt to rise core temperature, oral progesterone 100 mg was prescribed twice per day (Figure 3).