In this serial MRI study a 24 year old man presenting anterior spinal artery syndrome was examined. In the acute stage, spin echo sequences showed an enlarged cervical cord on a Ti weighted image and high signal intensity in the enlarged portion of the cord on a T2 weighted image. The findings were interpreted as oedema in the grey and white matter subsequent to ischaemia. In the chronic stage, inversion recovery techiques revealed a distinct focus in the anterior two thirds ofthe cord at the low cervical level. (7 Neurol Neurosurg Psychiatry 1992;55:838-840) Routine laboratory examinations were unremarkable. X rays of the skull, cervical spine and chest were normal. CSF pressure was 80 mmH2O, jugular compression test was normal, and the CSF was clear and colourless. The CSF protein content was 0-67 g/l on the second day and 0-28 on the twentieth day. Other CSF examinations, including cell count, IgG, myelin basic protein, and cytology were all normal.A myelogram showed an enlargement of the cervical cord. High resolution CT did not disclose any haematoma in the cord. Electromyography revealed anterior horn cell damages on C6 and C7, and somatosensory evoked potentials in the arms and legs demonstrated a conduction block above C7. MRI findings are described further below.The neurological deficit stabilised after the first 12 hours. The patient was treated with daily intravenous methylprednisolone, 1000 mg for three days and oral prednisolone 60 mg for four weeks. After the first week he gradually began moving his arms and hands again. Two weeks later marked spasticity, hyperreflexia of the legs and positive Babinski's signs appeared. While deep sensation returned to normal, the loss of pain and thermal sensation persisted below T4 ("dissociated sensory impairment"). Four weeks later atrophy of the small hand muscles became apparent. Muscle power of the deltoid, biceps and brachioradial muscles eventually returned to more than 50% of the normal measure, but recovery of the triceps muscle of the arms and distal muscles was limited to less than 25%, while the legs remained completely paraplegic. Urinary retention persisted and self catheterisation was required. The neurological findings did not change during the following 12 months and the patient became confined to a wheelchair. There has been neither progression nor recurrence for the last three years.
MRIMRI was performed on a Picker 0-5 tesla imager using the multislice, spin echo (SE) technique for TI weighted (TR = 500 ms, TE = 40 ms) and T2 weighted (TR = 1000 ms, TE = 120 ms) sequences and the inversion recovery (IR) technique for Ti weighted sequence (TR = 1500 ms, TI = 500 ms). We produced sagittal images with 838 on 11 May 2018 by guest. Protected by copyright.
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