Answer for BIR CoW 16 Sep 2018
Spinal cord contusion
Findings
Focal intramedullary cord hyperintensity noted at C5 &C6 levels- suggestive of spinal cord contusion No e/o spinal ligaments injury
Discussion
Traumatic spinal cord injury can manifest as a wide variety of clinical syndromes resulting from damage to the spinal cord or its surrounding structures. It is an emergency which can require urgent surgical intervention to prevent long-term neurological complications of spinal cord injury. Clinical presentation It is very variable ranging from minor neurological dysfunction to complete paralysis .Damage to the cord not only can vary in severity but also only affect certain tracts and result in incomplete cord syndromes . In addition to neurological signs (e.g. altered sensation, limb weakness, autonomic dysfunction, and sphincter disruption) there is usually pain due to related injury to the musculoskeletal components of the spine Pathology:There are several types of traumatic spinal cord injury : spinal cord swelling spinal cord contusion/oedema cord oedema only: most favourable prognosis cord oedema and contusion: intermediate prognosis cord contusion only: worse prognosis intramedullary haemorrhage extrinsic compression, e.g. from fracture fragment or disc herniation spinal cord transection Mechanism The mechanism of injury varies and can include: road traffic accidents sports injuries assault or gunshot injury Falls Classification Injuries can be complete or incomplete at a specified level. The most common system is the Internal Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) from the American Spinal Injury Association (ASIA) 2. Radiographic features Plain radiograph These have no real role in traumatic cord injury in patients with significant trauma as they have limited sensitivity for detecting spinal cord trauma and bony injuries associated with it. CT This is best for assessing the associated bony injuries which may need concomitant treatment consideration but does not assess the cord itself. MRI Apart from routine axial and sagittal T1 and T2 imaging additional sequences should be considered depending on the clinical concern. T2* sequences (e.g. gradient echo, SWI) are more sensitive to haemorrhage, while STIR sequences are more sensitive to associated ligamentous injury. spinal cord swelling focal cord enlargement at the level of trauma without signal change 5 best seen on sagittal T1 spinal cord oedema as per swelling but with additional increased T2 signalspinal cord contusion thick high T2 signal rim around small central low T1 signal above or below the level of trauma blooming on T2* sequences intramedullary haemorrhage thin high T2 signal rim around large central low T1 signal blooming on T2* sequences spinal cord transection discontinuity of cord best seen on sagittal sequences. Reference Grainger and Allison diagnostic radiology
Findings
Focal intramedullary cord hyperintensity noted at C5 &C6 levels- suggestive of spinal cord contusion No e/o spinal ligaments injury
Discussion
Traumatic spinal cord injury can manifest as a wide variety of clinical syndromes resulting from damage to the spinal cord or its surrounding structures. It is an emergency which can require urgent surgical intervention to prevent long-term neurological complications of spinal cord injury. Clinical presentation It is very variable ranging from minor neurological dysfunction to complete paralysis .Damage to the cord not only can vary in severity but also only affect certain tracts and result in incomplete cord syndromes . In addition to neurological signs (e.g. altered sensation, limb weakness, autonomic dysfunction, and sphincter disruption) there is usually pain due to related injury to the musculoskeletal components of the spine Pathology:There are several types of traumatic spinal cord injury : spinal cord swelling spinal cord contusion/oedema cord oedema only: most favourable prognosis cord oedema and contusion: intermediate prognosis cord contusion only: worse prognosis intramedullary haemorrhage extrinsic compression, e.g. from fracture fragment or disc herniation spinal cord transection Mechanism The mechanism of injury varies and can include: road traffic accidents sports injuries assault or gunshot injury Falls Classification Injuries can be complete or incomplete at a specified level. The most common system is the Internal Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) from the American Spinal Injury Association (ASIA) 2. Radiographic features Plain radiograph These have no real role in traumatic cord injury in patients with significant trauma as they have limited sensitivity for detecting spinal cord trauma and bony injuries associated with it. CT This is best for assessing the associated bony injuries which may need concomitant treatment consideration but does not assess the cord itself. MRI Apart from routine axial and sagittal T1 and T2 imaging additional sequences should be considered depending on the clinical concern. T2* sequences (e.g. gradient echo, SWI) are more sensitive to haemorrhage, while STIR sequences are more sensitive to associated ligamentous injury. spinal cord swelling focal cord enlargement at the level of trauma without signal change 5 best seen on sagittal T1 spinal cord oedema as per swelling but with additional increased T2 signalspinal cord contusion thick high T2 signal rim around small central low T1 signal above or below the level of trauma blooming on T2* sequences intramedullary haemorrhage thin high T2 signal rim around large central low T1 signal blooming on T2* sequences spinal cord transection discontinuity of cord best seen on sagittal sequences. Reference Grainger and Allison diagnostic radiology
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!