Case 37 - Spinal Cord Infarct

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAM: MRA SPINE W/ AND WO CONTRAST, MRI COMPLETE SPINE W/WO CONTRAST, MRI BRAIN STROKE WO CONTRAST AND MRA

INDICATION: 46 year old female hx of vascular myelopathy presenting with new R arm tingling, sensory changes, r/o cord infarct/worsening myelopathy.

COMPARISON: Prior brain 6/27/2020

TECHNIQUE: Multiplanar multisequence MRI of the brain performed without intravenous contrast. 3D brain MRA performed using time-of-flight MRA. 3D reconstructions were performed to evaluate vascular anatomy. MRA of the spine with contrast was performed. 8 cc of intravenous Gadavist was used. .

FINDINGS:

Brain Parenchyma: Scattered white matter T2 FLAIR hyperintensities are increased from 6/27/2020 (for example in the centrum semiovale bilaterally series 19 image 27). No hemorrhage, cerebral edema, acute cortical infarction, mass, mass effect, or midline shift, or abnormal susceptibility. Midline structures including pituitary fossa are normal.

Ventricles and Sulci: Normal

Extra-Axial Spaces: No extra-axial fluid collection.

Basal Cisterns: Normal

Intracranial Flow-Voids: Normal

Craniocervical junction: Normal

Paranasal Sinuses: Clear

Mastoid Sinuses: There

Orbits: Normal.

Cranium: Normal.

Postcontrast sequences of the brain were acquired.

MRA BRAIN:

POSTERIOR CIRCULATION:

Vertebral arteries: Left dominant. Patent bilaterally.

PICAs: Patent bilaterally.

Basilar artery: Patent

AICAs: Not visualized bilaterally.

Superior cerebellar arteries: Patent bilaterally

Posterior cerebral arteries: Patent bilaterally.

ANTERIOR CIRCULATION:

Internal carotid arteries: Visualized segments are patent bilaterally

Middle cerebral arteries: Patent bilaterally

Anterior cerebral arteries: Patent bilaterally

Posterior communicating arteries: Patent bilaterally

MRI SPINE:

Cord atrophy at C5-7 and the area of the previously seen myelopathy.

Increased signal on diffusion weighted imaging within the the myelopathic segment in the right lateral aspect of the cord with associated heterogeneous enhancement extending from C5-C7 (series 31 image 11, series 49 image 14).

Decreased patchy T2 hyperintensity in the dorsal columns the C2-3 level and in the left lateral spinal cord at C4.

T5 vertebral body hemangioma.

IMPRESSION:

MRI brain:

1. No acute stroke.

2. Increased number of white matter punctate T2 FLAIR hyperintensity since 6/27/2020. Likely progression of the underlying vasculopathy.

MRA brain:

No intracranial large vessel occlusion.

MRI spine:

1. Focal diffusion restriction and heterogeneous enhancement in the right lateral aspect of the spinal cord extending from C5-C7, within the segment of the previously seen myelopathy. Findings are suggestive of acute on chronic spinal cord

infarction/vascular insult.

2. Progressive atrophy of the myelopathic segment of spinal cord from C5 to C7 since 7/4/2020.