Clinical question: Evaluate for spinal cord infarct. Signs and symptoms: 9-year-old male with history of epidural lipomatosis, status post T3 -- T8 laminectomies now with bilateral leg paralysis. Pre-and post-enhanced cervical and thoracic MRI:Examination demonstrates increased T2 signal intensity and caliber of the cord extending from C5 inferiorly through the entire thoracic cord and reaching the conus consistent with extensive cord edema. The signal abnormality of the cord is more centrally located which is suggestive of an ischemic process. There is subtle inhomogeneity of the signal intensity of the cord. Although there is no distinct signal changes of acute bleed, possibility of minimal petechial hemorrhage however cannot be entirely excluded.Post-infused images demonstrate very faint patchy foci of suspected enhancement within the cervical and lower thoracic cord. This finding likely reactive and may represent leakage of contrast from the vasculature rather than a mass or vascular lesion.The overall appearance of this finding is highly suspected of a cord infarct. Less likely possibility of transverse myelitis cannot be entirely excluded.Diffusion-weighted images are suboptimal however demonstrate increased signal intensity of the thoracic cord which does not appear to extend to the cervical cord. This appearance may suggest presence of a cord infarct and vasogenic edema.Postoperative changes of multi-level laminectomy and with expected epidural enhancement at the surgical site and enhancement of posterior soft tissues of the upper is noted.
1.New since prior exam is diffuse cord increased T2 signal intensity and caliber extending from C5 through the conus and highly suggestive of ischemic stroke. Ill-defined faint foci of inhomogeneity of the cord raises the remote possibility of minimal associated hemorrhage. There are also very faint ill-defined patchy foci of high density on post infused images in the cervical and lower thoracic cord which is history of present enhancement or leakage of contrast from the vasculature.