Presentation
A previously well patient with a history of diarrhea in the morning developed sudden onset lower limb paralysis.
Patient Data
Long segment T2 weighted sagittal images showing heterogenous intensity in the single lesion with hypointense caudal and hyperintense anterior and cranial areas. Serpentine flow voids can be seen caudal to the lesion in the epidural space. On T1 images mild hyperintensity of the lesion compared to the cord was present with the lesion extending in both subdural and epidural locations. Significant indentation on the dorsal cord and draping at its anterolateral recess present. On post-contrast images no enhancement of the lesion was present.
Case Discussion
Intraspinal hematoma should be considered in patients with acute presentations and imaging with MRI is the 1st choice of investigation.
Pointers to hematoma instead of neoplasms are -
- Differential signals in T2W, due to multiple bleeding components.
- Ill defined borders of the lesion.
- No post-contrast enhancement.
- In some cases underlying causes of bleeding like dural AV fistula or AV malformations should be considered.
The patient was taken up for decompression surgery immediately after imaging and confirmed findings of hematoma and dural AV fistula. The hematoma was in epidural location. Coagulations of the AV fistula was undertaken.
After the evacuation of the hematoma patient's motor response improved immediately.