Emergency MRI has an important role in diagnosis and assessment of the extent of injury in patients with suspected stroke, suspected spinal cord injury, and suspected cauda equina sy ndrome. Such conditions require urgent assessment and management due to possible long-term complications.
Stroke
Magnetic resonance imaging (MRI) and computed tomography (CT) are not equally effective in diagnosing acute stroke.
MRI is widely considered superior to CT, but this claim has never been tested in the full range of patients in whom acute stroke is suspected.
Patients who present to the emergency department with stroke-like symptoms have cerebrovascular disease (ischaemic or haemorrhagic) or numerous other (nonvascular) issues.
Studies suggest that CT has low sensitivity for the detection of acute ischaemia, has high interrater variability in interpretation, and is not better than MRI for detecting acute intracranial haemorrhage
Methods
The cohort was divided into two groups according to whether the MRI occurred within 48 h (early) or later (late).
Logistic regression and Poisson log-linear models with adjustment for age, sex, stroke severity, acute stroke protocol (ASP) activation, thrombolytic
thrombectomy procedures were used to evaluate in-hospital, discharge, post-discharge and healthcare utilization outcomes.
Spinal cord injuries
It helps assess the type and level of spinal cord injury, assesses soft tissue injury associated with bone injury, and assists with pre-operative planning.
MRI provides information about the spine and spinal cord, particularly in cases where CT is limited and spinal cord compression or soft tissues injuries are involved.
The plexus of nerves located at the termination of the spinal cord is referred to as the cauda equina.
The spinal cord ends at the upper lumbar or lower back and the nerve roots exit, supplying motor and sensory function to the legs and bladder, travelling downward.
The cauda equina is nerves in the lumbar and sacral region of the spine.his means “horse tail” in Latin because of the resemblance to a horse’s tail.
Methods
This was a prospective observational study that was conducted at our hospital. The study cohorts included all patients who presented to us with cauda equina syndrome.
the gender, age, duration of symptoms, degree of strength loss, sensory loss and bladder/bowel disturbance.
All patients underwent further imaging with MRI, after which a final diagnosis was made. Based on the bladder symptoms, patients were an incomplete CES. Urinary retention was deemed to represent whilst symptoms of urinary urgency and straining were labelled as.
All patients were operated on within, depending on the first available operative slot available in the department.
Cauda Equina Syndrome
An emergency MRI for suspected Cauda Equina Syndrome (CES) is essential because of the risk of permanent paralysis and incontinence if not treated promptly.
The gold standard for diagnosis CES is MRI, and should have a low threshold to consider ordering if CES is suspected, even before discussion with a specialist.
Even though it occurs below the conus, cauda equina syndrome (CES) is considered an incomplete cord syndrome.
Cauda equina syndrome is most commonly due to an acutely extruded lumbar disc, and is considered a diagnostic and surgical emergency.
Methods
Assessment for Cauda Equina Syndrome (CES) requires a multifactorial clinical assessment to establish significant neurological compromise.
At the outset of the assessment, a high index of suspicion for “red flag” features should inform the diversity of the presenting history of symptoms.
These include severe back pain, bilateral sciatica, bowel and/or bladder dysfunction (urinary retention/incontinence), and saddle anaesthesia (loss of parody or genital sensation).
Neurological examination will require assessment of anal sphincter tone and voluntary contraction with digital rectal examination, pin prick testing of perianal sensation and bulbocavernosus reflex.
Bladder function is assessed via bedside ultrasound of the post-void residual urine volume – while a post-void residual is associated with an increased suspicion of CES, although recent studies indicated that of confirmed CES cases requiring emergency decompression had a post-void residual of, it is not adequate to rule out diagnosis.
Conclusion
Ultimately, emergency MRI is the golden standard for diagnosing these conditions when appropriate, but clinical urgency and/or resource limitations may require alternative imaging or treating the patient more rapidly. The best scenario for achieving the best patient outcome is to quickly identify, image, and consult with a specialist.
Frequently Asked Questions
Q. cauda equina considered a spinal cord injury?
No, while Cauda Equina Syndrome (CES) is not a spinal cord injury.
Q. What type of MRI is needed for cauda equina syndrome?
lumbar spine MRI with and without contrast
Q. What are the indications for an emergency MRI of the spine?
An emergency MRI of the spine is warranted when there is concern for significant spinal cord or nerve compromise, infection and major neurologic deficits,
Q. What is the best treatment for spinal cord injury?
It typically consists of an acute response, including medical intervention (if necessary), and subsequent rehabilitation to maximize functional recovery and/or quality of life.
Q. What is the cost of an MRI spine scan?
The spine MRI scan cost varies from 12000-15000 INR. It depends on the type of scan. If it’s only lumbar spine, cervical and dorsal spine, then the cost lies around 4500-5000 rs. Call carebox for more details.
