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3b - Answer: 64 year old male with severe low back pain

David Yousem MBA, MD
David M Yousem, MBA, MD
Professor of Radiology, Vice Chairman and Associate Dean
Includes DICOM files

Learn more about this case by reading the case report below. Additional instruction is provided in the Case Summary section of the course.

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Case Report

HISTORY: A 64 year old male with severe low back pain

TECHNIQUE:  Multiplanar multisequence magnetic resonance images of the lumbar spine  without intravenous contrast.

COMPARISON: CT the lumbar spine performed the same day.

FINDINGS:
There are acute blood products within the thecal sac the superior aspect of which is at L1 where the cauda equina are posteriorly displaced resulting in moderate narrowing of the spinal canal, more inferiorly there is continued posterior displacement of the nerve roots extending from L1-L3. At L3, the morphology of the cauda equina are suggestive of subdural components of hemorrhage (for instance series 5, image 20). Inferiorly there is a large likely subdural component of hemorrhage along the left dorsal lateral aspect of the thecal sac which displaces the cauda equina
nerve roots to the right. Extending from the L5 level inferiorly the cauda equina nerve roots are not well visualized within the thecal sac and likely completely effaced by the intrathecal hemorrhage. Component of subarachnoid hemorrhage within the thecal sac is also possible.

Lumbar spine demonstrates normal lordosis. No acute fracture or traumatic dislocation. Nonspecific heterogeneous marrow signal. There are mild degenerative changes of the lumbar spine without disc herniation.

IMPRESSION:
Multilobulated hematomas within the thecal sac spanning L1-S1, likely subdural in location resulting in marked mass effect on the cauda equina nerve roots. The degree of mass effect on the nerve roots is most severe at L5 where the cauda equina roots are not visualized on the basis of compression.

LESSON 2, TOPIC 9

Case Challenge: Spine MRI Cases - I-MED Study

Content reviewed: May 12, 2022