Article Figures & Data
Figures
- Fig 1.
Sagittal MR images of patient 8 showing thoracolumbar EDC 1 day post-LP. A, Noncontrast sagittal T1-weighted image (TR/TE, 638.3/14) shows low-signal-intensity EDC extending from at least T11-S1. The epidural fat pads are heterogeneous (arrows) secondary to infiltrating fluid. B, Sagittal T2-weighted image (TR/TE, 3260.9/125) shows high-signal-intensity EDC elevating and infiltrating “floating” epidural fat pads (long arrows) and deviating the dura anteriorly (short arrows).
- Fig 2.
Sagittal postcontrast MR images of patient 19 showing very extensive EDC 1 day post-LP. A, Contrast-enhanced T1-weighted image (TR/TE, 500/14) shows high-signal-intensity EDC, which extended from C7-L4 (cervical images not included). B, Contrast-enhanced T2-weighted image (TR/TE, 4000/115) shows very-high-signal-intensity EDC, hyperintense to CSF, with compression of the thecal sac and anterior deviation of the dura (short arrows). Heterogeneous floating fat pads (long arrows) are more obvious on the T2-weighted image.
- Fig 3.
MR images of patient 2 showing extensive EDC 1 day post-LP. A, Noncontrast T1-weighted image (TR/TE, 500/9) of the spine shows a low-signal-intensity EDC extending from the upper thoracic level of the spine to the sacral level. Elevated epidural fat pads (arrows) can be seen and appear heterogeneous due to fluid infiltration. B, Noncontrast T2-weighted image (TR/TE, 4000/126) of the spine shows high-signal-intensity EDC. Epidural fat pads (long arrows) are elevated, and the dura is deviated anteriorly (short arrows). C, Axial T2-weighted image (TR/TE, 4000/126) at the level of the conus shows heterogeneous signal intensity in the dorsal epidural space secondary to fluid elevating and infiltrating the epidural fat pads. There is resultant deviation of the dura anteriorly.
- Fig 4.
Sagittal MR images of patient 5 showing initial EDC 4 days post-LP and resolution of EDC 13 days later. A, Noncontrast sagittal T1-weighted image (TR/TE, 500/12) shows hypointense EDC extending from T12-S2. Epidural fat pads (arrows) are shown to be elevated and infiltrated with low-intensity fluid. B, Noncontrast sagittal T2-weighted image (TR/TE, 5000/135) obtained at the same time as A shows hyperintense fluid deviating the dura anteriorly (short arrows) effacing the CSF and elevating the fat pads (long arrows), which are infiltrated with fluid. C and D, Sagittal T1-weighted (C) (TR/TE, 500/12) and sagittal T2-weighted (D) (TR/TE, 5000/133) images obtained 17 days post-LP show resolution of EDC. Epidural fat pads (arrows) are normal in position and homogeneous. The dura is no longer deviated, and the intrathecal CSF is not effaced.
Tables
Summary: history and imaging findings
Patient No. Age/Sex Time Between LP and MR Imaging Post-LP Symptoms Leading to Spine MR Imaging Level of EDC EDC T1 SI Relative to CSF EDC Postcontrast SI Relative to CSF EDC T2 SI Relative to CSF 1 2 y 5 months/M 1 day LE pain, decreased LE reflexes T/L Low High 2 1 y 11 months/M 1 day Refusal to walk, pain with back straight T/L/S Low High 3 11 y/M 1 day Back and leg pain, right LE numbness T/L Low High 4 6 months/F 4 days Decreased LE motion T/L Low High 5 6 y 11 months/M 4 days LBP, unable to stand up, paraspinal muscle spasms T/L/S Low High 6 5 y 8 months/M 3 days Back pain, inability to stand straight/walk At least T10-L5 Low No CE High, minimal stranding 7 1 y 5 months/F 4 days Abnormal gait T/L Low Mild dural CE High 8 8 y 9 months/F 1 day Severe LBP, stooped posture At least T11-S1 Low High 9 11 y 10 months/M Unknown LBP At least T9-L4 Low High 10 3 y 2 months/F 1 day Refusing to walk, back/knee pain, weak LE T/L High High 11 1 y 5 months/M 2 days Back pain, refusal to walk At least T6-L5 Low High 12 1 y/M 4 days Increased inability to walk, pain on LE movement T/L Low High 13 4 y 7 months/M 1 day Back/LE pain, thigh/paraspinal muscle spasm T/L/S Mildly high High 14 5 y 5 months/M 1 day Severe back/LE pain, refusal to walk At least T7-S1 Low High 15 12 y 10 months/F 2 days Increased paresthesias, weakness in LE T/L Low No CE High 16 9 y 2 months/M 7 days Back/LE pain, recurring meningeal signs C/T/L Low Mild CE High 17 7 y 8 months/M 3 days HA, LE stiffness, back pain, vomiting/meningeal signs T/L Low No CE High 18 2 y 11 months/M 1 day Increased weakness, back/LE pain, unsteady gait T/L Minimally high High 19 1 y 4 months/M 2 days Inability to walk/stand T/L Low High 20 7 y 2 months/F 1 day Back pain C/T/L High Very high 21 6 y 11 months/M 2 days Ataxia, leg pain T/L/S Low Minimal CE High 22 4 y 7 months/F 3 days Right LE weakness, back pain T/L Low Mild CE High 23 13 y 1 month/F 3 days Severe back/LE pain At least T11-L4 Low High 24 4 y 3 months/M 1 day Bilateral hip-to-thigh pain L Minimally low, anterior enhancement 25 2 y 7 months/M 4 days Back and leg pain, stooped posture T/L Low High Note:—SI indicates signal intensity; LE, lower extremity; LBP, lower back pain; HA, headache; T, thoracic; L, lumbar; S, sacral; C, cervical; CE, contrast enhancement.
