E. Atallah, H. Saad, K. Bekelis, N. Chalouhi, S. Tjoumakaris, D. Hasan, Gorge Eller, D. Stidd, Md Mba Facs Faha Robert H. Rosenwasswer, P. Jabbour
Background: Despite the routine clopidogrel/aspirin anti-platelet therapy, complications like thromboembolism, continue to be encountered with PED. We studied the safety and the efficacy of prasugrel in the management of clopidogrel non-responders treated for intracranial aneurysms. Methods: 437 consecutive neurosurgery patients were identified between January 2011 and May 2016. Patients allergic or having <30% platelet-inhibition with a daily 75mg of clopidogrel were dispensed 10mg of prasugrel daily (n=20) or 90mg of ticagrelor twice daily (n=2). The average follow-up was 15.8 months (SD=12.4 months). Patient clinical well being was evaluated with the modified Rankin Scale (mRS) registered before the discharge and at each follow-up visit. To control confounding we used multivariable mixed-effects logistic regression and propensity score conditioning. Results: 26 of 437(5.9%) patients (mean of age 56.3 years; 62 women [14,2%]) presented with a sub-arachnoid hemorrhage. 1 patient was allergic to clopidogrel and prasugrel simultaneously. All the patients receiving prasugrel (n=22) had a mRS<2 on their latest follow-up visit (mean=0.67; SD=1.15). In a multivariate analysis, clopidogrel did not affect the mRS on last follow-up, p=0.14. Multivariable logistic regression showed that clopidogrel was not associated with an increased long-term recurrence rate (odds ratio[OR], 0.17; 95%Confidence Interval [CI95%], 0.01-2.70; p=0.21) neither with an increased thromboembolic accident rate (OR, 0.46; CI95%, 0.12-1.67; p=0.36) nor with an increased hemorrhagic event rate (OR, 0.39; CI95%,0.91-1.64; p=0.20). None of the patients receiving prasugrel deceased or had a long-term recurrence nor a hemorrhagic event, only 1 patient suffered from mild aphasia subsequent to a thromboembolic event. 3 patients on clopidogrel passed during the study: (2) from acute SAH and (1) from intra-parenchymal hemorrhage. Clopidogrel was not associated with an increased mortality rate (OR, 2.18; CI95%,0.11-43.27; p=0.61). The same associations were present in propensity score adjusted models. Conclusion
{"title":"The Use of Prasugrel and Ticagrelor in Pipeline Flow Diversion","authors":"E. Atallah, H. Saad, K. Bekelis, N. Chalouhi, S. Tjoumakaris, D. Hasan, Gorge Eller, D. Stidd, Md Mba Facs Faha Robert H. Rosenwasswer, P. Jabbour","doi":"10.29046/JHNJ.013.2.005","DOIUrl":"https://doi.org/10.29046/JHNJ.013.2.005","url":null,"abstract":"Background: Despite the routine clopidogrel/aspirin anti-platelet therapy, complications like thromboembolism, continue to be encountered with PED. We studied the safety and the efficacy of prasugrel in the management of clopidogrel non-responders treated for intracranial aneurysms. Methods: 437 consecutive neurosurgery patients were identified between January 2011 and May 2016. Patients allergic or having <30% platelet-inhibition with a daily 75mg of clopidogrel were dispensed 10mg of prasugrel daily (n=20) or 90mg of ticagrelor twice daily (n=2). The average follow-up was 15.8 months (SD=12.4 months). Patient clinical well being was evaluated with the modified Rankin Scale (mRS) registered before the discharge and at each follow-up visit. To control confounding we used multivariable mixed-effects logistic regression and propensity score conditioning. Results: 26 of 437(5.9%) patients (mean of age 56.3 years; 62 women [14,2%]) presented with a sub-arachnoid hemorrhage. 1 patient was allergic to clopidogrel and prasugrel simultaneously. All the patients receiving prasugrel (n=22) had a mRS<2 on their latest follow-up visit (mean=0.67; SD=1.15). In a multivariate analysis, clopidogrel did not affect the mRS on last follow-up, p=0.14. Multivariable logistic regression showed that clopidogrel was not associated with an increased long-term recurrence rate (odds ratio[OR], 0.17; 95%Confidence Interval [CI95%], 0.01-2.70; p=0.21) neither with an increased thromboembolic accident rate (OR, 0.46; CI95%, 0.12-1.67; p=0.36) nor with an increased hemorrhagic event rate (OR, 0.39; CI95%,0.91-1.64; p=0.20). None of the patients receiving prasugrel deceased or had a long-term recurrence nor a hemorrhagic event, only 1 patient suffered from mild aphasia subsequent to a thromboembolic event. 3 patients on clopidogrel passed during the study: (2) from acute SAH and (1) from intra-parenchymal hemorrhage. Clopidogrel was not associated with an increased mortality rate (OR, 2.18; CI95%,0.11-43.27; p=0.61). The same associations were present in propensity score adjusted models. Conclusion","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132096837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Harrop, J. Ratliff, Sonia Teufack, Jeffrey A Rihn, T. Albert, A. Vaccaro
Spine ABSTRACT Background: Odontoid fractures are the most common type of axis injury. Elderly patients can develop odontoid fractures after minor trauma with hyperextension injuries. The optimal treatment of type II fractures is controversial.
{"title":"Catastrophic Failure of Conservatively Treated Odontoid Fracture in the Elderly","authors":"J. Harrop, J. Ratliff, Sonia Teufack, Jeffrey A Rihn, T. Albert, A. Vaccaro","doi":"10.29046/jhnj.007.2.004","DOIUrl":"https://doi.org/10.29046/jhnj.007.2.004","url":null,"abstract":"Spine ABSTRACT Background: Odontoid fractures are the most common type of axis injury. Elderly patients can develop odontoid fractures after minor trauma with hyperextension injuries. The optimal treatment of type II fractures is controversial.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121404549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Dalyai, Vismay Thakkar, Thana Theofanis, P. Jabbour, L. Gonzalez, R. Rosenwasser, S. Tjoumakaris
Introduction Stroke is a major cause of serious, long-term disability and the third leading cause of death, accounting for one in every 18 deaths in the United States. Approximately 800,000 strokes occur in the United States each year, leading to an estimated cost of 74 billion dollars in 2010. The severity and prognosis of patients with an acute internal carotid artery (ICA) occlusion is extremely poor. Studies have shown that 16-55% of patients will die from complications related to the infarction, 40-69% will be left with a profound deficit, and only 2-12% will make a reasonable recovery2. In young patients, internal carotid artery dissections presenting as an acute occlusion or thrombotic clot are responsible for approximately 14-20% of ischemic strokes.1 Results from trials utilizing emergent open surgical carotid recanalization or IVtPA have not been encouraging2,3. Recently, there have been small case reports of endovascular stent-assisted thrombolysis as a treatment option for patients with carotid occlusions and near occlusions.4-8
{"title":"Endovascular Management of Acute Proximal Internal Carotid Artery Occlusion: the JHN Experience","authors":"R. Dalyai, Vismay Thakkar, Thana Theofanis, P. Jabbour, L. Gonzalez, R. Rosenwasser, S. Tjoumakaris","doi":"10.29046/JHNJ.006.1.001","DOIUrl":"https://doi.org/10.29046/JHNJ.006.1.001","url":null,"abstract":"Introduction Stroke is a major cause of serious, long-term disability and the third leading cause of death, accounting for one in every 18 deaths in the United States. Approximately 800,000 strokes occur in the United States each year, leading to an estimated cost of 74 billion dollars in 2010. The severity and prognosis of patients with an acute internal carotid artery (ICA) occlusion is extremely poor. Studies have shown that 16-55% of patients will die from complications related to the infarction, 40-69% will be left with a profound deficit, and only 2-12% will make a reasonable recovery2. In young patients, internal carotid artery dissections presenting as an acute occlusion or thrombotic clot are responsible for approximately 14-20% of ischemic strokes.1 Results from trials utilizing emergent open surgical carotid recanalization or IVtPA have not been encouraging2,3. Recently, there have been small case reports of endovascular stent-assisted thrombolysis as a treatment option for patients with carotid occlusions and near occlusions.4-8","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132110785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 48 year male presented to the ER with severe headaches which were episodic in nature and which had been present for several weeks. Patient had a history of traumatic head injury (TBI) several years prior. Otherwise, he was in good health with no significant past medical or surgical history. On physical exam, patient was oriented x 3 with an intact cranial nerve exam. He had significant upper and lower extremity spasticity with mild hand intrinsic weakness. His motor exam was otherwise unremarkable. His gait was very spastic. He had sustained lower extremity clonus, upgoing toes, and increased tone in the upper and lower extremities. His sensation was intact to light touch, pinprick, proprioception and temperature.
{"title":"Cervical Intramedullary Ganglioma","authors":"Harminder Singh, A. Sharan, John K. Ratliff","doi":"10.29046/JHNJ.004.2.006","DOIUrl":"https://doi.org/10.29046/JHNJ.004.2.006","url":null,"abstract":"A 48 year male presented to the ER with severe headaches which were episodic in nature and which had been present for several weeks. Patient had a history of traumatic head injury (TBI) several years prior. Otherwise, he was in good health with no significant past medical or surgical history. On physical exam, patient was oriented x 3 with an intact cranial nerve exam. He had significant upper and lower extremity spasticity with mild hand intrinsic weakness. His motor exam was otherwise unremarkable. His gait was very spastic. He had sustained lower extremity clonus, upgoing toes, and increased tone in the upper and lower extremities. His sensation was intact to light touch, pinprick, proprioception and temperature.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131242513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Commentary: Tele-ICU Development and Application","authors":"Annalise DeJesus, M. Athar","doi":"10.29046/jhnj.012.1.005","DOIUrl":"https://doi.org/10.29046/jhnj.012.1.005","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132638401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Incidence and Prevalence of Deep Vein Thrombosis Among Neurocritical Intensive Care Unit Patients","authors":"A. Dolla, M. Vibbert","doi":"10.29046/jhnj.012.1.009","DOIUrl":"https://doi.org/10.29046/jhnj.012.1.009","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121679070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Understanding Neurosurgery Through Experimental and Computer Models","authors":"C. Randazzo, A. Pandey, E. Veznedaroglu","doi":"10.29046/JHNJ.004.1.003","DOIUrl":"https://doi.org/10.29046/JHNJ.004.1.003","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125467092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Farber Hospitalist Service – Last 5 Years of a Service Dedicated to the Medical Management of Neurosurgical Patients","authors":"René Daniel, C. Harrop","doi":"10.29046/jhnj.015.1.001","DOIUrl":"https://doi.org/10.29046/jhnj.015.1.001","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133236205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Case Report on Intracranial Hemorrhage Related to Type I Cryoglobulinemia","authors":"R. Dalyai, L. Gonzalez","doi":"10.29046/JHNJ.006.2.005","DOIUrl":"https://doi.org/10.29046/JHNJ.006.2.005","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121953832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Disc degeneration or spondylosis, when severe, may lead to the development of a vacuum phenomenon in the spine caused by gas production. This gas is visible on plain X-ray films, and is even more clearly apparent on computed tomography (CT) imaging, but may not be apparent on MRI. We present the case of a 69 year-old female with MRI appearing to exhibit a significant L4-5 disc herniation that, on further imaging with CT, was determined to be air in the epidural space without disc herniation. The importance of correlating clinical presentation, neurologic examination, and multimodal imaging is stressed. CASE REPORT History and Presentation: A 69-year old female presented with musculoskeletal low back pain extending into her hips and thighs, in a non-radicular manner. She was neurologically intact and had received physical therapy and epidural steroid injections without symptomatic relief. Imaging: Anterior-posterior and lateral plain films of the thoracic and lumbar spine were unremarkable. T2-weighted MRI images showed marked loss of disc height at L4-L5, with a large central disc herniation and an “extruded disc fragment” resulting in left greater than right foraminal stenosis (Figures 1). A subsequent spine CT, however, revealed air in the L4-L5 disc space consistent with vacuum disc phenomenon which was chronic and appeared on abdominal ct scans done several years prior (Figure 2). DISCUSSION Gas production or “vacuum phenomenon” in the intervertebral space may be a byproduct of disc degeneration. Accumulated gas is composed of nitrogen and carbon dioxide and remains within the disc space.1,2 Gas may escape into the epidural space through a fissure in the annulus fibrosus. The vast majority of individuals with epidural gas are asymptomatic. Gas in the intervertebral disc space is a relatively common radiologic finding and is found in approxi- mately 46% of CT examinations.3 Air in the disc can be seen as a signal void on T1and T2-weighted MRI, however, CT is more sensitive for identifying air in the disc or epidural space. On T2-weighted MRI, disc herniations appear as isoto hypointense material extending beyond the confines of the disc space. These findings are often associated with the loss of disc height at the level of the herniated disc.4,5 These very findings were observed in the T2-weighted imaging of our patient (Figures 1 and 2). Our patient presented with low back pain and no symptoms consistent with radiculopathy referable to L4-L5. Despite the findings seen on MRI, the CT clearly illustrated air in the L4-L5 disc space and left anterolateral portion of the epidural space (Figure 2). In light of the clinical presentation and CT findings, the MRI findings were deemed to be the result of epidural air and the patient was treated with conservative management. We present a case of contrasting imaging findings as an example of the importance of correlating clinical presentation, neurologic examination, and multimodal imaging in the treatm
当椎间盘退变或颈椎病严重时，可能导致脊柱出现真空现象，产生气体。这种气体在x射线平片上可见，在计算机断层扫描(CT)上更明显，但在MRI上可能不明显。我们报告一位69岁女性的病例，MRI表现为明显的L4-5椎间盘突出，进一步的CT成像确定为硬膜外腔空气，无椎间盘突出。强调了将临床表现、神经系统检查和多模态成像相关联的重要性。病例报告病史和表现:一名69岁女性，腰背部肌肉骨骼性疼痛延伸至臀部和大腿，呈非神经根性。她的神经系统完好，接受了物理治疗和硬膜外类固醇注射，但症状没有缓解。影像学:胸椎、腰椎前后侧位平片无明显异常。t2加权MRI图像显示L4-L5椎间盘高度明显下降，伴有较大的中央椎间盘突出和“椎间盘碎片突出”，导致左侧椎间孔狭窄大于右侧(图1)。然而，随后的脊柱CT显示，L4-L5椎间盘间隙显示空气，与几年前腹部ct扫描中出现的慢性真空椎间盘现象一致(图2)。讨论椎间隙气体产生或“真空现象”可能是椎间盘退变的副产物。积聚的气体由氮气和二氧化碳组成，并留在阀瓣空间内。1,2气体可通过纤维环的裂缝进入硬膜外间隙。绝大多数有硬膜外气体的人是无症状的。椎间盘间隙气体是一种相对常见的放射学表现，约占CT检查的46%椎间盘内的空气在t1和t2加权MRI上可视为信号空洞，而CT对椎间盘或硬膜外间隙内的空气识别更为敏感。在t2加权MRI上，椎间盘突出表现为等向低信号物质，超出了椎间盘间隙的范围。这些表现通常与椎间盘突出处的椎间盘高度下降有关。这些发现在患者的t2加权成像中被观察到(图1和2)。患者表现为腰痛，没有与L4-L5神经根病一致的症状。尽管MRI上有此表现，但CT清楚显示L4-L5椎间盘间隙和硬膜外间隙左前外侧有空气(图2)。结合临床表现和CT表现，认为MRI表现为硬膜外空气所致，并对患者进行保守治疗。我们提出一个对比成像结果的病例，作为临床表现、神经系统检查和多模态成像在背痛治疗中的重要性的一个例子。引用1。Ford LT, Gilula LA, Murphy WA, Gado M.真空腰椎间盘气体分析。J·J·伦琴诺。128年6月1977;(6):1056 - 1057。2. Yoshida H, Shinomiya K, Nakai O, Kurosa Y, Yamaura I.腰椎内气体引起的腰神经根压迫。报告三例病例。《脊椎》(费城出版社1976)。1997年2月1日;22(3):348-351。3.李建军，李建军，李建军，等。脊髓真空现象的CT诊断及临床意义。J计算机辅助系统。8月1982;6(4):671 - 676。4. vidman T, Battie MC, Gill K, Manninen H, Gibbons LE, Fisher LD.胸椎和腰椎的磁共振成像结果及其相关性。脊柱退变的发病机制。《脊椎》(费城出版社1976)。1995年4月15日;20(8):928-935。5. 桥本K, Akahori O, Kitano K, Nakajima K, Higashihara T, Kumasaka Y.腰椎间盘突出症的磁共振成像。与脊髓造影的比较。《脊椎》(费城出版社1976)。11月1990;15(11):1166 - 1169。图2轴位CT图像清晰显示低衰减信号，代表椎间盘内侧和左侧前外侧硬膜外腔内有空气。图1 (A) t2加权轴向MRI显示左侧前外侧硬膜外腔低信号区。最初，这被认为是椎间盘突出，后来根据CT评估修改为硬膜外腔偶然发现的空气。(B) t2加权矢状位MRI。一个
{"title":"Air in the L4-5 Epidural Space Appearing as Disc Herniation","authors":"Angud Mehdi, P. Amenta, J. Harrop","doi":"10.29046/JHNJ.007.2.005","DOIUrl":"https://doi.org/10.29046/JHNJ.007.2.005","url":null,"abstract":"Disc degeneration or spondylosis, when severe, may lead to the development of a vacuum phenomenon in the spine caused by gas production. This gas is visible on plain X-ray films, and is even more clearly apparent on computed tomography (CT) imaging, but may not be apparent on MRI. We present the case of a 69 year-old female with MRI appearing to exhibit a significant L4-5 disc herniation that, on further imaging with CT, was determined to be air in the epidural space without disc herniation. The importance of correlating clinical presentation, neurologic examination, and multimodal imaging is stressed. CASE REPORT History and Presentation: A 69-year old female presented with musculoskeletal low back pain extending into her hips and thighs, in a non-radicular manner. She was neurologically intact and had received physical therapy and epidural steroid injections without symptomatic relief. Imaging: Anterior-posterior and lateral plain films of the thoracic and lumbar spine were unremarkable. T2-weighted MRI images showed marked loss of disc height at L4-L5, with a large central disc herniation and an “extruded disc fragment” resulting in left greater than right foraminal stenosis (Figures 1). A subsequent spine CT, however, revealed air in the L4-L5 disc space consistent with vacuum disc phenomenon which was chronic and appeared on abdominal ct scans done several years prior (Figure 2). DISCUSSION Gas production or “vacuum phenomenon” in the intervertebral space may be a byproduct of disc degeneration. Accumulated gas is composed of nitrogen and carbon dioxide and remains within the disc space.1,2 Gas may escape into the epidural space through a fissure in the annulus fibrosus. The vast majority of individuals with epidural gas are asymptomatic. Gas in the intervertebral disc space is a relatively common radiologic finding and is found in approxi- mately 46% of CT examinations.3 Air in the disc can be seen as a signal void on T1and T2-weighted MRI, however, CT is more sensitive for identifying air in the disc or epidural space. On T2-weighted MRI, disc herniations appear as isoto hypointense material extending beyond the confines of the disc space. These findings are often associated with the loss of disc height at the level of the herniated disc.4,5 These very findings were observed in the T2-weighted imaging of our patient (Figures 1 and 2). Our patient presented with low back pain and no symptoms consistent with radiculopathy referable to L4-L5. Despite the findings seen on MRI, the CT clearly illustrated air in the L4-L5 disc space and left anterolateral portion of the epidural space (Figure 2). In light of the clinical presentation and CT findings, the MRI findings were deemed to be the result of epidural air and the patient was treated with conservative management. We present a case of contrasting imaging findings as an example of the importance of correlating clinical presentation, neurologic examination, and multimodal imaging in the treatm","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127440186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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