Aoyama T, Hida K, Akino M, Yano S, Iwasaki Y, Saito H
Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan.
Spinal Cord. 2007 Oct;45(10):695-9. doi: 10.1038/sj.sc.3102014. Epub 2007 Jan 9.
Case report.
Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital and Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
A patient presented to us with complete C4 tetraplegia after a 3-m fall. MRI performed 120 min after his fall showed spinal canal stenosis due to disk protrusion at the C3/4 level without spinal cord signal changes on T1- and T2-weighted images. He underwent laminoplasty between C2 and C6. Intraoperative ultrasound, performed 6 h after his fall, disclosed a hyperechoic lesion at the C3/4 level of the cervical cord; postoperative T2-weighted MRI, obtained at 8 h after his fall, showed high intensity at the same level.
In patients with cerebral infarction, approximately 6 h between the insult and the acquisition of T2-weighted MRI are required to detect signal changes. We postulate that the time course on MRI scans obtained immediately after spinal cord injury is similar in patients with spinal cord injury and cerebral infarction and suggest that the absence of spinal cord abnormalities in the ultra-early post-injury stage is not always predictive of a good prognosis.
病例报告。
日本札幌麻布神经外科医院神经外科及北海道大学医学研究生院神经外科，札幌。
一名患者在坠楼3米后出现完全性C4四肢瘫。坠楼后120分钟进行的MRI检查显示，C3/4水平椎间盘突出导致椎管狭窄，T1加权像和T2加权像上脊髓信号无改变。他接受了C2至C6椎板成形术。坠楼后6小时进行的术中超声检查显示，颈髓C3/4水平有一个高回声病变；坠楼后8小时进行的术后T2加权MRI检查显示，同一水平有高强度信号。
在脑梗死患者中，损伤与获取T2加权MRI之间大约需要6小时才能检测到信号变化。我们推测，脊髓损伤患者脊髓损伤后立即进行的MRI扫描的时间进程与脑梗死患者相似，并表明损伤超早期脊髓无异常并不总是预示着良好的预后。
