Introduction: Spinal cord concussion (SCC) is still an area of conflict, possibly because it has not been as thoroughly studied as cerebral concussion has been or because of its infrequent incidence. The pathophysiology of SCC is unknown[1, 2]. The spinal cord injuries are classified as concussions if they meet three criteria: 1) spinal trauma immediately precedes the onset of neurological deficits, 2) neurological deficits are consistent with spinal cord involvement at the level of injury, and 3) complete neurological recovery occurs within 72 hours after injury. Unfortunately, traditional radiological imaging techniques do not provide clear evidence of SCC and are often unremarkable. Diffusion tensor imaging (DTI) has emerged as a technique that allows for the evaluation of white matter integrity through the assessment of fractional anisotropy (FA) of tracts. A study has demonstrated group differences in DTI parameters between traumatic brain injury (TBI) patients and post-concussion syndrome as compared to controls. The patients displayed significant reduction in FA compared to the controls (P < 0.05) in several tracts.
Results: DTI of the upper C-spine segment of our patient revealed a significant decrease in FA values of tracts on the right side of the spinal cord as compared to the left side. These results are consistent with the patient’s presentation of right-sided weakness post-trauma. When the FA values on the left and right sides were compared at lower segments of the spinal cord, no significant differences were found; a result that is also consistent with the absence of symptoms at lower levels.
Conclusions: This report suggests a possible use of DTI in the diagnosis of SCC by comparing the differences in FA values in different sections of the spinal cord at various levels. Changes in FA values indicate a change in the integrity of the white matter tracts in question.
Patient Care: It will draw attentions to use of DTI in the diagnosis of SCC for better management.
Learning Objectives: 1.Define Spinal Cord Concussion Syndrome.
2.Discuses the possible use of DTI in the diagnosis of SCC.
3.Explain the fractional anisotropy (FA) values and its role in diagnosis of SCC.
References: 1.Denny-Brown, D. and W.R. Russell, Experimental cerebral concussion. Brain, 1941. 64(2-3): p. 93-164.
2.Gurdjian, E. and H. Voris, Report of ad hoc committee to study head injury nomenclature. Clin Neurosurg, 1966. 12: p. 386-394.
3.Zwimpfer, T.J. and M. Bernstein, Spinal cord concussion. Journal of neurosurgery, 1990. 72(6): p. 894-900.
4.D’souza, M.M., et al., Traumatic brain injury and the post-concussion syndrome: A diffusion tensor tractography study. The Indian journal of radiology & imaging, 2015. 25(4): p. 404.