PMC7758642_01
Imaging findings showing progression of spinal cord infarction. A) Sagittal T2-weighted MR image of the lumbar spine from the day of initial presentation is normal. B) Sagittal T2-weighted MR image of the lumbar spine on the day after symptom onset (day 2) demonstrates patchy intramedullary T2 hyperintensity in the anterior cord with parenchymal expansion of the conus. There is notably no abnormal intervertebral disc signal or loss of disc height. C) Sagittal T1-weighted post-gadolinium imaging also from day 2 shows mild vascular prominence without abnormal cord or nerve root enhancement. D) Sagittal T2-weighted MR image of the thoracic spine from the spinal angiogram on day 3 demonstrates progression of cord signal abnormality to the T9 level and remaining ventral. E) Sagittal diffusion weighted image from the same exam showed restricted diffusion corresponding to areas of signal abnormality though slightly more apparent at the T9 level. F) Sagittal T2-weighted MR image of the thoracic spine obtained on day 5 shows signal abnormality is further progressed with extension to the level of T7, again remaining ventral.
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PMC7758642_01_10.1177_2329048X20981295-fig1.jpg
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MRI lumbar spine without contrast obtained about 6 hours after symptom onset (Figure 1A) was negative for cord signal change, vertebral/disc abnormalities, or masses. MRI thoracic/lumbar spine with contrast obtained 1 day after symptom onset showed new development of T2 hyperintensity within the anterior portion (anterior horns) of the distal thoracic cord (T10) to the conus medullaris (Figure 1B-C). MRI findings were most consistent with acute spinal cord infarction. MR spine angiogram with diffusion weighted sequences were obtained 2 days after symptom onset and showed extension of T2 hyperintensity rostrally to T9 with diffusion-weighted imaging showing restricted diffusion most notable at level T9 (Figure 1D-E). MRI cervical spine was obtained 4 days after symptom onset (day 5) to assess the remainder of the spine, which showed extension of T2 hyperintensity rostrally to T7 (Figure 1F).