Presentation
Assaulted with a machete.
Patient Data
Obliquely oriented low signal abnormality on T1 and T2, within the posterior paraspinal region extending from left to right to the interlaminar interval at C4/C5, consistent with gas. Surrounding this there is high signal within the posterior paraspinal muscles and ligaments, on T2 and STIR weighted images which extends into the subcutaneous tissues posteriorly. There is disruption of supraspinous and interspinous ligaments, with extension into the central canal with disruption of the dura/ligamentum flavum. Loss of the normal posterior epidural T2 high signal at this level. Abnormal disc high STIR signal at the C4/C5 level. There is T2 hyperintense cord signal abnormality at the level of C4/C5, extending for approximately 1 cm consistent with probable cord injury/edema. The left C4/C5 facet appears 'perched'.
There is signal abnormality within the posterior paraspinal region consistent with disruption of the supraspinous and interspinous ligaments, as well likely disruption of the posterior dura/ligamentum flavum at C4/C5. Subluxed left C4-5 facet. T2 cord signal abnormality at this level, consistent with direct cord injury. Findings suggest an unstable spinal injury.
Case Discussion
This case illustrates a spinal cord injury following a penetrating stab wound.
Case courtesy of Associated Professor Pramit Phal
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