MR IMAGING OF CHRONIC SPINAL CORD INJURY

Spinal cord injury is a devastating trauma resulting in variable degree of neurological deficits, depending upon the severity of cord damage. Neurological outcome depends not only upon the extent of initial cord injury but also on the superimposed chronic sequel and wallerian degeneration. Spinal cord injury has variable appearance on imaging in acute and chronic phase, recognition of which is important not only for adequate and timely treatment but also for prognostication. Recognition of wallerian degeneration is also important as it is another independent cause of delayed neurological deterioration. We report a case of young child with spinal cord injury presenting in chronic phase with neurological deterioration due to development of extreme degree of spinal cord atrophy distal to the site of injury which is very rare and can be attributed to severe degree of distal wallerian degeneration. We also review the literature for chronic spinal cord injuries and wallerian degeneration with emphasis on various causes of delayed neurological deterioration and consequent importance of recognizing them by imaging.