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Trauma Cases from Harborview Medical Center

Predicting Neurologic Outcome with MR Imaging in a Patient

in Spinal Shock
Sharon K. Wallace1 and Anthony M. Avelhino2

A previously healthy 70-year-old woman was apneic and brady- sistent with acute intraspinal hemorrhage and the presence of deoxyhe-
cardic (24 beats/mm) following a fall from a standing position. She moglobin; Type II injuries reflect cord edema and manifest high signal
was intubated, resuscitated, and air-lifted to our trauma center, intensity on T2 weighting; and Type Ill injuries demonstrate a normal
where she remained comatose (Glasgow Coma Scale 3T) and with- MR signal on Ti-weighted sequences and mixed signal on T2-weighted
out spontaneous respiration despite stable vital signs. Neurological sequences and correlate with cord contusion.
examination showed signs of high spinal cord injury, including The anatomic level of acute intrapanenchymal cord hemorrhage
absence of cough and gag reflexes, no rectal sphincter tone, flaccid correlates strongly with the neurological level of injury [3-6]. The lit-
paralysis and areflexia of upper and lower extremities. The clinical erature suggests that intraparenchymal hematoma almost always
diagnosis was spinal shock. indicates a complete and irreversible cord lesion. Bondurant et al. [3]
Noncontrast CT of the head was normal. An unstable type 3 odon- found that patients with a Type I cord injury on MR imaging failed to
toid fracture, shown on cross-table lateral cervical spine radiograph, improve their neuromuscular function between admission and an
was reduced with traction. Cervical spine CT (Fig. 1A) and MR imaging average follow-up of i year. In contrast, 21 of 27 patients with Type II
(Figs. i B and i C) were performed to stage the osseous and soft-tissue or Ill cord injuries improved significantly.
injuries, respectively. MR imaging showed an acute cervical intramedul-
lany hematoma (Fig. 1 B) and partial cord transection atthe C2 level and REFERENCES
edema of several adjacent segments of the spinal cord (Fig. 1C). 1 . Schwenker D. Cardiovascular considerations in the critical care phase.
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Spinal shock, a neurological and cardiovascular complex [1 ], may nal cord injury: a study using physical examination and magnetic reso-

complicate injuries to the upper thoracic (above T6) and cervical nance imaging. Spine 1990:15:161-1 68
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5. Flanders AE, Schaefer DM, Doan HT, Mishkin MM, Gonzalez CF,
the injury site. In this setting, MR imaging findings can be used to NorthrupBE. Acute cervical spine trauma: correlation of MR imaging find-
establish the prognosis for return of neurologic function [2, 3]. ings with degree of neurologic deficit. Radiology 1990:177:25-33
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intensity on Ti weighting and low signal intensity on 12 weighting, con- severity of neurologic injury. Spine 1989;1 4: 1 090-i 095

Fig. 1.-Type Ill odontoid fracture and cervical cord Injury in patient with spinal shock.
A, Coronal reformation of helical CT scan (1-mm thickness, 1.4:1 pitch) shows type III odontoid fracture of C2 (arrow).
B, T2-weighted MR Image of cervical spine demonstrates partial transection (curved black arrow) of cervical cord at C2 and high signal within cord
over several segments, consistent with cord edema (straight black arrow).
C, saglttal MR Image of cervical spine using multipianar gradient-recalled echo sequence shows intraparenchymal hematoma (black arrow).

This is another in the continuing series on radiology in trauma cases from the Harborview Medical Center. Editors: Fred A. Mann and Lee B. Talner.
1 Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Ave. , ZA-65, Seattle, WA 981 04. Address cor-
respondence to F.A. Mann.
Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98104.
AJR 1995:165:108 0361-803X/95/1651-108 © American Roentgen Ray Society