0:01

This was a patient who was

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transferred to Johns Hopkins

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from an outside facility.

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She was a nurse who was bending

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over doing her laundry at home

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and developed sudden onset of

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bilateral thigh numbness and

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paresthesias and worsening

0:19

bilateral lower extremity

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weakness.

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She had an MRI on the outside,

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which showed a T7-8 central disc

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herniation that was causing

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spinal stenosis,

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and there was some mild high

0:33

signal intensity at that level

0:35

in the spinal cord.

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The patient underwent a T8

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laminectomy and discectomy,

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and after the surgery,

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she developed flaccid paralysis

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of her lower extremities,

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no deep tendon reflexes,

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no tone dyskinesia,

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and had some absence

0:56

of sensation.

0:58

So what we see on this

1:00

Ah T2-weighted scan is the

1:02

evidence of the decompressive

1:03

Laminectomy at the T7-8

1:06

level with the disc herniation.

1:08

And he knows that there is

1:09

abnormal signal intensity in the

1:11

spinal cord over an extensive

1:15

level, extending down to the very

1:18

tip of the conus medullaris.

1:19

Well,

1:20

that would be very unusual for

1:23

spondylo myelopathy from

1:25

a thoracic spinal cord,

1:27

especially since you have the

1:29

large cord expansion down here

1:31

in the conus medullaris.

1:33

So this was the patient's

1:35

examination at the outside

1:37

hospital showing the acute

1:39

surgical changes as well as the

1:43

fluid collection in

1:44

the operative bed.

1:46

And there was a spotty area of

1:48

contrast enhancement in

1:49

the spinal cord.

1:51

So it was unclear

1:52

postoperatively why the patient

1:55

was having so much difficulty.

1:59

She arrived.

2:00

To our facility and subsequently

2:04

underwent diffusion-weighted

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imaging three days after

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The surgery.

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The diffusion-weighted scan.

2:13

Is pretty dramatic in showing.

2:15

Marked hyperintensity to the.

2:19

Spinal cord from that disc level.

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Down to the conus medullaris.

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And this is.

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Again, the DWI scan.

2:31

You always want to confirm with.

2:33

Your ADC map that you're not.

2:36

Seeing T2 shine.

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Through effect.

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This is the ADC map from the.

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Diffusion-weight scan.

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You can see that indeed.

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The spinal cord is dark.

2:44

In signal intensity.

2:46

Identifying this as a spinal.

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Cord infarction now.

2:50

It's unclear.

2:51

Even in retrospect, what was the?

2:53

Etiology for the patient's?

2:54

Spinal cord infarction with?

2:56

Respect to whether or not there?

2:58

Was an incident that occurred?

3:00

During the surgery,

3:01

either of hypotension or whether?

3:04

Or not, in a strange?

3:07

Bizarre way?

3:08

The patient's vascular supply?

3:11

Was compromised by?

3:13

A laminectomy.

3:14

That would be very unusual.

3:16

Since, as I said,

3:16

the interior spinal artery is?

3:18

The main supply and that's?

3:19

Anterior to where they?

3:21

Were operating on.

3:22

If they were performing?

3:23

A diskectomy,

3:25

Which is from the posterior?

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Approach,

3:29

Theoretically they may have?

3:31

Injured the anterior spinal?

3:32

Artery either through retraction?

3:34

Or compression. But again,

3:38

It was not clear,

3:39

Even reconstructing the history,

3:41

What went on.

3:42

But I did want to show this nice.

3:43

Example of the diffusion-weighted.

3:46

Imaging and the ADC map in a.

3:48

Patient who had a spina.

3:50

Cord infarction.

3:51

On the follow-up T2.

3:53

Weighted imaging.

3:55

You can see that that.

3:58

Cord expand.

4:00

Tension is not progressing.

4:03

It looks a little bit better.

4:05

Down at the CONUS medullarisin.

4:08

Cauda quina region of the spinal.

4:11

Cord down at the thoracic.

4:14

Lumbar junction.

4:15

So spinal cord infarctions will.

4:18

Occur maybe once or twice in.

4:21

A year at Johns Hopkins.

4:23

It's that uncommon.

4:25

And there's usually an unusual.

4:29

Manifestation or an unusual.

4:30

Presentation of the patients.

4:32

As in this case.