0:00

I'm going to use this case to transition to

0:05

traumatic injuries of the spinal cord, as well as

0:09

vascular injuries to the spinal cord.

0:12

On T1-weighted imaging of this young patient who had

0:18

pain after a fall while landscaping,

0:23

you see bright signal intensity on T1-weighted imaging.

0:28

This is in the mid to lower thoracic region.

0:34

The spinal cord at that level is not

0:37

particularly expanded. However,

0:39

we see other areas on the T2 and STIR imaging

0:43

of hemorrhage within the spinal cord.

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I have to admit that this was performed

0:50

about a week after the patient's initial presentation.

0:54

And so, some of the cord enlargement that you

0:57

would expect with hemorrhage in the spinal cord

1:00

has resolved.

1:01

When you have hemorrhage in the spinal cord,

1:04

there is a differential diagnosis.

1:07

Obviously, with the clinical history of

1:09

a fall while landscaping,

1:11

you'd suggest that this was a post traumatic

1:13

injury to the spinal cord.

1:15

However, we know that ependymomas have that

1:18

predilection for a little hemosiderin cap within the tumor.

1:21

Demyelinating disorders, unlikely.

1:23

Infectious etiology,

1:25

sometimes toxoplasmosis may show some hemorrhage.

1:28

So that's in a differential diagnosis.

1:31

And then we have our vascularities that may

1:34

occur and injure the spinal cord with either a

1:37

cord stroke or a cord hemorrhagic infarction.

1:41

In point of fact,

1:42

this patient ended up having two possible

1:45

etiologies, or three, I should say.

1:48

There was the traumatic event while landscaping.

1:51

However, this patient also carried a diagnosis

1:54

of Kawasaki's disease,

1:56

which is an obliterative vasculitis.

2:00

Which could cause a hemorrhagic injury to the

2:03

spinal cord that's not associated with cord

2:07

enlargement at the one to two week mark,

2:10

but in point of fact, would lead to cord myelomalacia.

2:15

His CSF, however, was positive for herpes.

2:19

So we also have the possibility of an infectious

2:22

etiology that might be hemorrhagic.

2:24

Herpes, a little bit unusual,

2:27

certainly for herpes simplex

2:29

or those other herpetic viruses, varicella.

2:32

However, with herpes zoster, there is a possibility that this

2:37

could have been hemorrhagic.

2:38

So this patient ended up being discharged with

2:40

a final diagnosis of Kawasaki's disease

2:43

with herpetic myelitis

2:47

in the setting of a traumatic event.

2:50

This will be our transition to discussing

2:53

traumatic injuries to the spinal cord, as well

2:56

as vascular injuries to the spinal cord.