Introduction
Traumatic spinal cord injury can manifest as a wide variety of clinical syndromes resulting from damage to the spinal cord or its surrounding structures. Magnetic resonance imaging (MRI) has become the gold standard for imaging neurological tissues including the spinal cord due to high sensitivity for detection of acute soft tissue and cord injuries.
Case reports
A 34-year-old female patient presented to our clinic with symptoms of both upper and lower limbs weakness, hypoesthesia below the C4 dermatome level and voiding difficulty about 2months after car accident. At that time of the accident, she was pregnant and had an abortion with vaginal bleeding after the accident. Cervical spine MRI, lumbar spine MRI and whole spine T2 saggital MRI revealed no abnormal findings with the exception of C6-C7 central disc protrusion and L4-L5 central spinal stenosis. Brain MRI was performed, but it did not reveal any abnormal findings. Voiding cystourethrography and urodynamic tests were also performed owing to subjective reports of persistent dysuria. Hyposensitive, hypotonic, and areflexic bladder findings were confirmed and clean intermittent catheterization regimen was prescribed to promote optimal bladder emptying. Electromyographic findings were left C7,C8, L5 and S1 dermatome somatosensory pathway dysfunction. The patient's deep tendon reflex was hyperreflexic and the symptoms of motor weakness and hypoesthesis gradually worsened, especially on the left side. International standards for neurological classification of spinal cord injury by American Spinal Injury Association/International Spinal Cord Society(ASIA/ISCOS) revealed a neurologically incomplete spinal cord injury. ASIA impairment scale was D and neurological level of injury was C4. The presenting clinical signs were suspicious of an underlying traumatic spinal cord injury. However, there were no objective evidence of spinal cord injury on MRI.
Discussion
The patient's symptoms were more severe on the left side, suggesting that there was more damage in the left side of the spinal cord. MRI over time has become a valuable diagnostic tool in diagnosing spinal cord injury in both pediatric and adult patients. The imaging technique offers a superior ability in identifying soft tissue lesions including cord edema, hematomas and transections, and disco-ligamentous injuries that may not be visualized by plain radiography and CT imaging. However, despite the lack of any evidence of spinal cord injury on MRI, injury cannot be completely ruled out.
Conclusion
We observed a patient who was suspected to have a traumatic onset cervical level spinal cord injury following a motor vehicle accident. There were no abnormal findings on MRI to support our clinical suspicion. Despite the negative test results by imaging, we concluded that an underlying spinal cord injury should not be ruled out strictly by the lack of abnormal findings on MRI. |
