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Images in Neurology
October 28, 2019

The Mask Sign—An Imaging Marker of Traumatic Spinal Cord Hemorrhage

Author Affiliations
  • 1Department of Radiology and Biomedical Imaging, University of California, San Francisco
JAMA Neurol. 2019;76(12):1515-1516. doi:10.1001/jamaneurol.2019.3320

An elderly man presented to the emergency department after falling out of bed with quadriplegia, urinary and stool incontinence, and hypothermia (temperature, 33.1°C). Additionally, a physical examination revealed absent rectal tone with complete sensory loss, which was consistent with an American Spine Injury Association A-level complete spinal cord injury (SCI). Magnetic resonance imaging (MRI) of the cervical spine showed an unstable spinal dislocation at C4 and C5 with jumped facets and severe spinal cord compression (Figure 1). At the level of the maximum SCI, which was below the dislocation at the level of C5 and C6, diffusion-weighted imaging (DWI) revealed reduced diffusion in the spinal cord white matter, outlining a hypointense signal of the central gray matter; this indicated a peripheral cytotoxic white matter injury with a more central gray matter hemorrhage (Figure 2). The pattern resembled a mask.

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