Presentation
4/7 fever -treating for infection ?urine vs chest. One year of left sided arm and leg weakness. O/E elbow extension and thumb abduction 3/5 , wasting of arm. Left leg 2/5 throughout. Normal sensation all limbs. CT head nil. Old missed infarct ? cervical myelopathy ?
Patient Data
1.3 cm focus of marked susceptibility artefact ('blooming') in the left sided of the cord at the level of the C5/C6 disc space.
No osseous abnormality. No significant central canal or exit foraminal stenosis.
Comment: Blood product based cervical cord lesion - differential cavernoma and prior hematoma.
This would correlate to the patient's symptoms
Case Discussion
Blood product based cervical cord lesion - differential cavernoma and prior hematoma.
Given the absence of a history of trauma or cervical surgery and the chronic history identified during an admission for an alternative indication a cavernoma is most likely.
The gradient echo sequence was added 'on table'. There are some great advantages of this kind of active radiological input:
- team work with radiographer colleagues who highlight the abnormality when the patient is on table
- one visit for the patient with a definitive report; convenient, efficient and money saving
- professional gratification in coming to a speedy diagnosis
I cannot highlight enough how good clinical information, dialog with clinical colleagues and feedback adds to the enjoyment of being a clinical radiologist as well as providing the highest standard of patient care.