LONG SEGMENT >3 vertebral segments

INDEX

                                                                                

                                                                                                                         Short Segment Myelopathy                       MCQs on this topic   

SNAKE EYES

LOCATION
 

SAGITTAL T2

POST CONTRAST

Other features

Typically thoracolumbar.
Long or Short: short segment
lesions  commonest1.

 

Single Lesion     

Hyperintense signal (iso on T1)2
Pencil-like hyperintensity1 (especially with anterior spinal
artery infarction).
Linear Strip

Owl's eye appearance: anterior horns and 
adjacent white matter bilaterally  (ASA infarct)

Posterior columns or posterior paramedian
 triangular hyperintensity (PSA infarct).

Enhancement in minority (diffuse/patchy)3, 4

  • Diffusion restriction
  • Vertebral body infarct with marrow
    signal changes5
  • Adjacent artery dissection.
  • Visualization of the artery of Adamkiewicz
    by 
    MR angiography2
  • Lateral and midline disc herniation6.

 

 

 

From: Amoiridis G, Ameridou I, Mavridis M. Intervertebral disk and vertebral body infarction as a confirmatory sign of spinal cord ischemia. Neurology. 2004 Nov 9;63(9):1755. doi: 10.1212/01.wnl.0000142973.33952.68. PMID: 15534280.

 

 

 

 

 

 

 

        AXIAL T2


    
 
 

 

From: Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol. 2006 Aug;63(8):1113-20. doi: 10.1001/archneur.63.8.1113. PMID: 16908737.

Note: Image orientation as per MRI convention, with anterior horn shown at top of the page

 

 

 

 

 

 

 

 

 


 

References

1            Yadav N, Pendharkar H, Kulkarni GB. Spinal Cord Infarction: Clinical and Radiological Features. J Stroke Cerebrovasc Dis 2018; 27: 2810–21.

2            Vargas MI, Gariani J, Sztajzel R, et al. Spinal Cord Ischemia: Practical Imaging Tips, Pearls, and Pitfalls. Am J Neuroradiol 2015; 36: 825–30.

3            Flanagan EP. Autoimmune myelopathies, 1st edn. Elsevier B.V., 2016 DOI:10.1016/B978-0-444-63432-0.00019-0.

4            Yuh WTC, Marsh EE, Wang AK, et al. MR imaging of spinal cord and vertebral body infraction. Am J Neuroradiol 1992; 13: 145–54.

5            Amoiridis G, Ameridou I, Mavridis M. Intervertebral disk and vertebral body infarction as a confirmatory sign of spinal cord ischemia. Neurology 2004; 63: 1755.

6            Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol 2006; 63: 1113–20.