Sequential changes of ascending myelopathy after spinal cord injury on magnetic resonance imaging: A case report of neurologic deterioration from paraplegia to tetraplegia

Seiji Okada, Takeyuki Saito, Osamu Kawano, Mitsumasa Hayashida, Yoshihiro Matsumoto, Katsumi Harimaya, Yukihide Iwamoto

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background context Marked neurologic deterioration within a few days of traumatic spinal cord injury, known as subacute posttraumatic ascending myelopathy, is rare. Although several hypotheses regarding the pathogenesis of this condition have been proposed, the details remain elusive.

Study design Case report and review of the literature.

Patient sample A 75-year-old woman involved in a motor vehicle collision sustained a fracture dislocation of T7-T8 with complete paraplegia below T8.

Methods Neurologic examination and radiologic imaging taken by various means.

Results Posterior surgical stabilization was performed 18 hours after the injury. Both the surgical and postsurgical courses were uneventful. Four days after the injury, however, the patient reported feeling a tingling sensation in the right-hand fingers and gradually suffered from motor weakness of the upper extremities, deteriorating within a few hours to complete tetraplegia and ventilator dependence. Subsequent cervicothoracic MRI showed abrupt cord swelling with abnormal areas of signal intensity in the cervical and upper thoracic spinal cord during the interval between the onset of tingling and the development of motor paralysis in the arms. On the 20th postsurgical day, an area of hypointensity within the region of high intensity was observed on T2-weighted MRIs, indicating intramedullary spinal cord hemorrhage.

Conclusions Our MRI findings suggest that systemically increased intraspinal pressure resulting from the impairment of spinal venous drainage is involved in the pathogenesis of ascending myelopathy. Although ascending myelopathy is often thought to be partly reversible, persisting increase of the intraspinal pressure may result in intramedullary hemorrhage and irreversible neurologic deficit.

Original languageEnglish
Pages (from-to)e9-e14
JournalSpine Journal
Volume14
Issue number12
DOIs
Publication statusPublished - Dec 1 2014

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Quadriplegia
Spinal Cord Diseases
Paraplegia
Spinal Cord Injuries
Nervous System
Magnetic Resonance Imaging
Spinal Cord
Hemorrhage
Pressure
Wounds and Injuries
Neurologic Examination
Motor Vehicles
Mechanical Ventilators
Neurologic Manifestations
Upper Extremity
Paralysis
Fingers
Drainage
Emotions
Arm

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

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title = "Sequential changes of ascending myelopathy after spinal cord injury on magnetic resonance imaging: A case report of neurologic deterioration from paraplegia to tetraplegia",
abstract = "Background context Marked neurologic deterioration within a few days of traumatic spinal cord injury, known as subacute posttraumatic ascending myelopathy, is rare. Although several hypotheses regarding the pathogenesis of this condition have been proposed, the details remain elusive.Study design Case report and review of the literature.Patient sample A 75-year-old woman involved in a motor vehicle collision sustained a fracture dislocation of T7-T8 with complete paraplegia below T8.Methods Neurologic examination and radiologic imaging taken by various means.Results Posterior surgical stabilization was performed 18 hours after the injury. Both the surgical and postsurgical courses were uneventful. Four days after the injury, however, the patient reported feeling a tingling sensation in the right-hand fingers and gradually suffered from motor weakness of the upper extremities, deteriorating within a few hours to complete tetraplegia and ventilator dependence. Subsequent cervicothoracic MRI showed abrupt cord swelling with abnormal areas of signal intensity in the cervical and upper thoracic spinal cord during the interval between the onset of tingling and the development of motor paralysis in the arms. On the 20th postsurgical day, an area of hypointensity within the region of high intensity was observed on T2-weighted MRIs, indicating intramedullary spinal cord hemorrhage.Conclusions Our MRI findings suggest that systemically increased intraspinal pressure resulting from the impairment of spinal venous drainage is involved in the pathogenesis of ascending myelopathy. Although ascending myelopathy is often thought to be partly reversible, persisting increase of the intraspinal pressure may result in intramedullary hemorrhage and irreversible neurologic deficit.",
author = "Seiji Okada and Takeyuki Saito and Osamu Kawano and Mitsumasa Hayashida and Yoshihiro Matsumoto and Katsumi Harimaya and Yukihide Iwamoto",
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T1 - Sequential changes of ascending myelopathy after spinal cord injury on magnetic resonance imaging

T2 - A case report of neurologic deterioration from paraplegia to tetraplegia

AU - Okada, Seiji

AU - Saito, Takeyuki

AU - Kawano, Osamu

AU - Hayashida, Mitsumasa

AU - Matsumoto, Yoshihiro

AU - Harimaya, Katsumi

AU - Iwamoto, Yukihide

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Background context Marked neurologic deterioration within a few days of traumatic spinal cord injury, known as subacute posttraumatic ascending myelopathy, is rare. Although several hypotheses regarding the pathogenesis of this condition have been proposed, the details remain elusive.Study design Case report and review of the literature.Patient sample A 75-year-old woman involved in a motor vehicle collision sustained a fracture dislocation of T7-T8 with complete paraplegia below T8.Methods Neurologic examination and radiologic imaging taken by various means.Results Posterior surgical stabilization was performed 18 hours after the injury. Both the surgical and postsurgical courses were uneventful. Four days after the injury, however, the patient reported feeling a tingling sensation in the right-hand fingers and gradually suffered from motor weakness of the upper extremities, deteriorating within a few hours to complete tetraplegia and ventilator dependence. Subsequent cervicothoracic MRI showed abrupt cord swelling with abnormal areas of signal intensity in the cervical and upper thoracic spinal cord during the interval between the onset of tingling and the development of motor paralysis in the arms. On the 20th postsurgical day, an area of hypointensity within the region of high intensity was observed on T2-weighted MRIs, indicating intramedullary spinal cord hemorrhage.Conclusions Our MRI findings suggest that systemically increased intraspinal pressure resulting from the impairment of spinal venous drainage is involved in the pathogenesis of ascending myelopathy. Although ascending myelopathy is often thought to be partly reversible, persisting increase of the intraspinal pressure may result in intramedullary hemorrhage and irreversible neurologic deficit.

AB - Background context Marked neurologic deterioration within a few days of traumatic spinal cord injury, known as subacute posttraumatic ascending myelopathy, is rare. Although several hypotheses regarding the pathogenesis of this condition have been proposed, the details remain elusive.Study design Case report and review of the literature.Patient sample A 75-year-old woman involved in a motor vehicle collision sustained a fracture dislocation of T7-T8 with complete paraplegia below T8.Methods Neurologic examination and radiologic imaging taken by various means.Results Posterior surgical stabilization was performed 18 hours after the injury. Both the surgical and postsurgical courses were uneventful. Four days after the injury, however, the patient reported feeling a tingling sensation in the right-hand fingers and gradually suffered from motor weakness of the upper extremities, deteriorating within a few hours to complete tetraplegia and ventilator dependence. Subsequent cervicothoracic MRI showed abrupt cord swelling with abnormal areas of signal intensity in the cervical and upper thoracic spinal cord during the interval between the onset of tingling and the development of motor paralysis in the arms. On the 20th postsurgical day, an area of hypointensity within the region of high intensity was observed on T2-weighted MRIs, indicating intramedullary spinal cord hemorrhage.Conclusions Our MRI findings suggest that systemically increased intraspinal pressure resulting from the impairment of spinal venous drainage is involved in the pathogenesis of ascending myelopathy. Although ascending myelopathy is often thought to be partly reversible, persisting increase of the intraspinal pressure may result in intramedullary hemorrhage and irreversible neurologic deficit.

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