Printer Friendly

Radiological case of the month: Guenther J. Kraus, MD.

CASE SUMMARY

A 60-year-old woman underwent spinal anesthesia for abdominal surgery. One day later, the patient presented with paresthesia in her lower legs. T2*-weighted and T2-weighted magnetic resonance imaging (MRI) showed intramedullary bleeding in the central portion of the medullary cone (Figures 1 and 2). This was due to an inadvertent puncture during the administration of spinal anesthesia.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

IMAGING FINDINGS

T2*-weighted gradient-recalled echo (GRE) imaging shows the smallest amounts of intramedullary hematoma (Figure 1) in the medullary cone. T2-weighted turbo spin-echo (TSE) imaging yields a high signal of the fluid-equivalent portion (ie, serum) of the hemorrhagic lesion (Figure 2).

DIAGNOSIS

Intramedullary bleeding after inadvertent puncture of the medullary cone

DISCUSSION

Inadvertent puncture of the spinal cord is a rare cause of neurologic deficit following spinal anesthesia. (1) This patient had paresthesia in her lower legs (numbness and tingling). The reason for the patient's complaints was postpuncture intramedullary bleeding in the medullary cone. MRI, especially T2*-weighted GRE imaging, can be very useful in detecting the smallest amounts of intramedullary bleeding (2) because of the paramagnetic effect of iron that is contained in hemoglobin (Figure 1). Furthermore, fluids, such as serum, are depicted as a bright signal on T2-weighted sequences (Figure 2).

CONCLUSION

When there is a suspected hemorrhagic lesion of the medulla, MRI should be the first imaging modality that is used.

REFERENCES

(1.) Hyderally H. Complications of spinal anesthesia. Mt Sinai J Med. 2002;69(1-2):55-56.

(2.) Yamada N, Imakita S, Nishimura T, et al. Evaluation of the susceptibility effect on gradient echo phase images in vivo: A sequential study of intracerebral hematoma. Magn Reson Imaging. 1992;10: 559-571.

Prepared by Guenther J.Kraus, MD, Department of Radiology, General Hospital Graz-West, Graz, Austria.

Guenther J. Kraus, MD
COPYRIGHT 2006 Anderson Publishing Ltd.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2006 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Kraus, Guenther J.
Publication:Applied Radiology
Date:Nov 1, 2006
Words:297
Previous Article:Radiological case of the month: C. Frank Gould, MD; Aaron J. Binstock, MD; Justin Q. Ly, MD; Scot E. Campbell, MD; Douglas P. Beall, MD.
Next Article:Nuclear medicine of the painful joint replacement.


Related Articles
Clozapine helps violent patients.
Radiological case of the month: Baha Al-Shawwa, MD and Mutasim Abu-Hasan, MD.
Radiological case of the month: Ann Kim, MD and Erini Makariou, MD.
Radiological case of the month: Barton F. Lane, MD and Clint W. Sliker, MD.
Radiological case of the month: Djamil Fertikh, MD, and Mounir Fertikh, MD.
Radiological case of the month: Garrett L. Walworth, MD, and Joon K. Kim, MD.
Radiological case of the month: Charles Ariz, MD and Katarzyna J. Macura, MD, PhD.
Radiological case of the month: Eric Eugene Beltz, MD and Todd Loring Siegal, MD.

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters