Fujimura Y, Watanabe M, Kihara M, Akasaka K
Department of Orthopaedic Surgery, School of Medicine, Keio University, Japan.
Injury. 1998 Jun;29(5):377-9. doi: 10.1016/s0020-1383(97)00155-1.
A 68-year-old male had neck pain and weakness of the left upper extremity after a fall. MRI showed severe cervical canal stenosis and a high signal intensity of the spinal cord on T2-weighted images extending from the medulla oblongata to the C7 level. Neurological examination showed left hemiparesis, bilateral sensory disturbance and a neurogenic bladder. He underwent expansive laminoplasty 5 weeks later. After the operation his neurological deficit improved and 6 weeks later he left the hospital. However, his neurological conditions became worse (quadriparesis) and he was admitted as an emergency 3 weeks later. Although MRI showed decompression of the spinal cord, the area of high signal intensity on T2-weighted images had extended. Quadriparesis was progressive and he died of dyspnea. Autopsy showed the presence of the intramedullary spinal cord tumor (anaplastic astrocytoma; C1-Th4). We could not detect the intramedullary spinal cord tumour on MRI before surgery because of severe canal stenosis and the history of trauma. The high spinal intensity on T2-weighted images was thought to be oedema or myelomalacia. This case illustrates the difficulty of correctly interpreting MRI in patients with severe canal stenosis.
一名68岁男性在跌倒后出现颈部疼痛和左上肢无力。MRI显示严重的颈椎管狭窄，在T2加权图像上脊髓呈高信号强度，从延髓延伸至C7水平。神经学检查显示左侧偏瘫、双侧感觉障碍和神经源性膀胱。5周后他接受了扩大椎板成形术。术后其神经功能缺损有所改善，6周后出院。然而，3周后他的神经状况恶化（四肢瘫痪）并作为急诊入院。尽管MRI显示脊髓减压，但T2加权图像上的高信号强度区域有所扩大。四肢瘫痪呈进行性发展，他最终死于呼吸困难。尸检显示存在髓内脊髓肿瘤（间变性星形细胞瘤；C1-Th4）。由于严重的椎管狭窄和外伤史，我们在术前的MRI上未能检测到髓内脊髓肿瘤。T2加权图像上的高脊髓信号强度被认为是水肿或脊髓软化。该病例说明了在严重椎管狭窄患者中正确解读MRI的困难。
