Acute biparalysis with low back pain and dysfunctional stool for more than 10 days. What should I consider when viewing a film for diagnosis?

*Only for medical professionals to read for reference.
Diagnosis depends on MRI and DSA.
Male, 26 years old
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Acute paralysis of lower limbs with low back pain and dysfunctional stool for more than 10 days
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Neurology physical examination: Consciousness, no special cranial nerves
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The muscle strength of both upper limbs is level 5, the muscle strength of both lower limbs is about level 2, and the pain sensation below L1 is decreased
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The tendon reflexes of both lower extremities are low, and the pathological signs of both lower extremities are suspicious
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Nerve root traction sign (+)
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Look at the image below, what do you consider the patient’s diagnosis? ---Answer dividing line---Are you sure you want to see the answer? ▌ Clinical image analysis on T1WI (A) showed intramedullary oval and small high-intensity foci at T12 level.
T2WI (B) also showed high-intensity, accompanied by a slightly low-intensity peripheral edema zone, which was consistent with subacute hemorrhage
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Re-examination of MR1-T1WI (C, D) 9 months later showed blood absorption, showing that the segment of spinal cord had a curved strip and beaded empty signal, suggesting spinal cord vascular malformation
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▌ Imaging diagnosis of spinal cord vascular malformations
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 A.
▌ discussion points for young male patients with acute paralysis of both lower extremities occur with low back pain, no trauma, history of infection
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MRI is a typical subacute phase of spinal cord hemorrhage
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B.
Usually 10 days to 3 weeks after hemorrhage is the subacute late stage, the red blood cells are completely disintegrated, and the hematoma is mainly composed of methaemoglobin
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High signal on T1WI and T2WI
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C.
It is worth noting that after the bleeding is completely absorbed, the re-examination of the MRI reveals the intramedullary curved strip and beaded empty signal, which indicates the spinal vascular malformation.
The diagnosis can be further confirmed by DSA
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References: [1]Zhang HJ, Silva N, Solli E, et al.
Treatment options and long-term outcomes in pediatric spinal cord vascular malformations: a case report and review of the literature[J].
Child's Nervous System, 2020, 36(12): 3147-3152.
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