Date : 00.00.00
Name of the Patient : Abc Xyznmlmn / M / 25 yrs.
Referred by : Dr. Abc Xyzchale.
Examination : M.R.I. of the Dorsal Spine.
CLINICAL PROFILE :
H/O fever with chills on 00.00.00.
C/O retention of urine 2 days back.
Patient HIV +ve.
M.R.I of the dorsal spine was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
10 mm thick T1 Weighted and T2 Weighted axial images.
The dorsal spinal cord appears slightly increased in diameter and shows a patchy ill-defined, hyperintense signal on the T2 Weighted images, centrally, over the D2 to D11 vertebral levels (better appreciated on axial images). This signal appears isointense to the normal cord on the T1 Weighted images.
The intrathecal CSF in the visualized dorsal and lumbar regions appears more hyperintense than normal.
There is a small, collection, intradurally, along the posterior margin of the dorsal spinal cord over the D5 to D7 vertebral levels. This lesion is slightly hyperintense to CSF on all the pulse sequences and is best appreciated on the sagittal T2 Weighted images (scans 105.4, 103.5).
The visualized dorsal vertebral bodies and intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
There is no cord compression.
Screening images of the cervical spine reveals patchy hyperintense signal on the T2 Weighted images in the cervical spinal cord. Screening images of the lumbar spine reveal a slightly hyperintense signal of the CSF on the T1 Weighted images as compared to normal.
1. Altered signal of the intrathecal CSF in the dorsal and lumbar regions as described may suggest an infective/inflammatory meningeal pathology, with subsequent arachnoiditis.
2. Patchy altered signal in the dorsal spinal cord, centrally, over the D2 to D11 vertebral levels most likely represents infective/inflammatory myelitis.
3. Small, intradural collection along the posterior margin of the dorsal spinal cord over the D5 to D7 vertebral levels may represent a small effusion/granulation tissue, in the given clinical setting.
A contrast enhanced scan may be useful.