RCOM RADIOLOGICAL CASE OF THE MONTH

A 60-year-old woman underwent spinal anesthesia for abdominal surgery. One day later, the patient presented with paresthesia in her lower legs. T2*-weighted and T2-weighted magnetic resonance imaging (MRI) showed intramedullary bleeding in the central portion of the medullary cone (Figures 1 and 2). This was due to an inadvertent puncture during the administration of spinal anesthesia.

T2*-weighted gradient-recalled echo (GRE) imaging shows the smallest amounts of intramedullary hematoma (Figure 1) in the medullary cone. T2-weighted turbo spin-echo (TSE) imaging yields a high signal of the fluid-equivalent portion (ie, serum) of the hemorrhagic lesion (Figure 2).

Intramedullary bleeding after inadvertent puncture of the medullary cone

Inadvertent puncture of the spinal cord is a rare cause of neurologic deficit following spinal anes-thesia.¹ This patient had paresthesia in her lower legs (numbness and tingling). The reason for the patient’s complaints was postpuncture intramedullary bleeding in the medullary cone. MRI, especially T2*-weighted GRE imaging, can be very useful in detecting the smallest amounts of intramedullary bleeding² because of the paramagnetic effect of iron that is contained in hemoglobin (Figure 1). Furthermore, fluids, such as serum, are depicted as a bright signal on T2-weighted sequences (Figure 2).

When there is a suspected hemorrhagic lesion of the medulla, MRI should be the first imaging modality that is used.