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


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.




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).


Intramedullary bleeding after inadvertent puncture of the medullary cone


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).


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


(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
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Author:Kraus, Guenther J.
Publication:Applied Radiology
Date:Nov 1, 2006
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