Copyright
©The Author(s) 2023.
World J Clin Cases. Mar 26, 2023; 11(9): 2074-2083
Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.2074
Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.2074
Table 1 Overview of reported cases of conus infarction
Ref. | Age/gender | Risk factors | Pathogeny/mechanism | Prognosis | MRI findings | |||
T2WI I high signal (Axial) | T2WI high signal (Sagittal) | DWI high signal | Involve centrum/muscle/ligament | |||||
Herrick et al[5] | 84/M | NA | Aortic dissection aneurysm | Partial improvement, died of rupture of aortic dissection aneurysm on the 18th day of admission | NA | NA | NA | NA |
79/M | Heart failure | Aortic atherosclerosis | No improvement, died of acute myocardial infarction on the 25th day of admission | NA | NA | NA | NA | |
Anderson et al[6] | 54/M | Coronary diseaseHeart failure | Aortic balloon pump implantation | Some improved strength in the legs before death 7 wk after the ictus | NA | NA | NA | NA |
75/M | Smoking | Repair operation of abdominal aortic aneurysm | Persistent urinary incontinence with some improvement in bowel function and in motor and sensory signs 16 mo after the ictus | NA | NA | NA | NA | |
66/M | Smoking | Aortic atherosclerosis | Some functions recovered 2 mo after the ictus | NA | NA | NA | NA | |
51/M | Smoking | NA | Persistent urinary incontinence with some functions recovered 28 mo after the ictus | NA | NA | NA | NA | |
47/F | NA | NA | No improvement in 2 yr | NA | NA | NA | NA | |
Ohbu et al[7] | 69/F | Hypertension | NA | NA | NA | NA | NA | NA |
Andrews et al[8] | 71/F | NA | NA | Walking independently, mild hypoesthesia, but persistent urinary incontinence 2 mo after the ictus | NA | NA | NA | NA |
Mhiri et al[9] | 28/M | NA | Dural arteriovenous fistula | No improvement | NA | NA | NA | NA |
Sinha et al[10] | 63/M | HypertensionCoronary disease | Coronary artery bypass grafting (CABG) | persistent urinary incontinence 5 yr after the ictus | NA | NA | NA | NA |
Greiner-Perth et al[11] | 66/M | NA | NA | No improvement in 8 mo | NA | T12-L1 | NA | NA |
Combarros et al[12] | 69/F | Hypertension | NA | The bladder function returned to normal and can walk with a walker 2 mo after the ictus | NA | NA | NA | NA |
Wildgruber et al[13] | 44/F | NA | Spinal venous thrombosis | Motor function recovered partially and leaving hypoesthesia 6 mo after the ictus | Bilateral anterior horn of gray matter (Snake-eye appearance) | T12-L1 | NA | NA |
Wong et al[14] | 79/F | Coronary disease | Aortic atherosclerosis | Partial neurologic recovery | Bilateral gray matter and central white matter | T12-L1 | Yes | NA |
Konno et al[15] | 77/F | Hypertension | Spinal venous thrombosis | Symptoms improved rapidly | Diffuse | L1 | NA | Yes |
Diehn et al[16] | 24/M | NA | Fibrocartilage embolism | No improvement | Bilateral anterior horn of gray matter | T10-L1 | NA | Yes |
Alanazy[17] | 48/M | NA | Overstretch | Walking resumed on day 105 | Diffuse | T11-L1 | NA | NA |
Hor et al[18] | 51/F | NA | NA | NA | Bilateral gray matter and central white matter | T12 | NA | NA |
Kamimura et al[19] | 70/F | NA | Spinal venous thrombosis | Sensory disturbance improved, leaving numbness in the sellar area and urinary incontinence | Bilateral posterior funiculus, right posterior horn, right lateral funiculus | T12 | NA | Yes |
Weng et al[20] | 55/M | Hyperlipidemia | Sofa sedentary | Calf muscle atrophy, perianal hypoesthesia and neurogenic bladder 3 yr after ictus | Bilateral anterior horn of gray matter | T11-12 | Yes | Yes |
34/F | NA | Toilet sedentary | Calf muscle atrophy, perianal hypoesthesia and neurogenic bladder 4 yr after ictus | NA | T12 | Yes | NA | |
Breitling et al[21] | 52/M | NA | NA | Motor function recovered partially, leaving bladder and rectum dysfunction | Bilateral anterior horn of gray matter (Snake-eye appearance) | L1 | NA | Yes |
Table 2 Identification of common diseases related to snake eye sign
Disease | Clinical features | Magnetic resonance performance | Neuroelectrophysiological manifestations |
Conus medullaris infarction[38] | The main manifestations are sensory disturbance in the sellar region, bladder and rectal incontinence, bulbar anal reflex weakening or disappearing, erectile dysfunction, root neuralgia and lower limb motor neuron paralysis when combined with cauda equina damage | T12-L1 horizontal magnetic resonance T2WI and DWI high signal, T1W1 low signal | There are few reports about the neurophysiological characteristics of conus medullaris infarction. The reappearance of F wave after infarction may mark the improvement of clinical prognosis |
Hirayama disease[39] | The self-limited disease, which is mainly characterized by unilateral muscle atrophy of the distal end of the upper limb, mainly affects the intrinsic muscles of the hand and forearm muscle groups. Typical clinical manifestations also include "cold paralysis", "finger extension tremor" and "muscle bundle tremor" | Asymmetric cervical spinal cord flattening, atrophy and intramedullary T2W1 high signal in cervical flexion position, disappearance of cervical physiological flexion, expansion and increase of epidural venous plexus, and anterior displacement of dural sac after over-extension and over-flexion position | The neurogenic damage of the affected muscle group mainly occurred in the C7-8 sarcomere and T1 sarcomere, while the C5-6 sarcomere (i.e. deltoid, biceps brachii and radial brachii) was not affected |
Amyotrophiclateralsclerosis[34] | Malignant degenerative motor neuron disease characterized by multiple or localized progressive muscular atrophy and apraxia is characterized by limb spasms, tendon hyperreflexia, localized or multiple muscle weakness, muscular atrophy and fascicular tremor | T2WI, FLAIR and DWI can find symmetrical high signal in the pyramidal tract of the brain. In a few patients, SWI can see the deposition of hemosiderin along the motor cortex | The muscles innervated by different nerve segments of medulla oblongata, neck, chest and lumbosacral appear progressive denervation and chronic nerve regeneration |
Cervical spondylotic myelopathy[40] | Based on cervical degeneration, the main manifestation is atrophy of the proximal or distal muscles of the upper limb, which usually occurs in one side, usually without sensory abnormalities | It is usually manifested as spinal cord thinning, intervertebral disc protrusion or prolapse. Due to long-term compression of the spinal cord, venous hyperemia and infarction can be caused, which can be secondary to cystic necrosis of the anterior horn of the spinal cord, forming T2WI snake-eye sign | Segmental neurogenic damage consistent with the distribution of the injured nerve root |
Spinal muscular atrophy syndrome[41] | The most common autosomal recessive disease in childhood is progressive and symmetrical weakness and atrophy of limbs and trunk muscles | Anterior horn of spinal cord α- Degeneration and degeneration of motor neurons led to T2WI snake-eye sign | Typical neuronal damage, fiber fibrillation wave and positive sharp wave can be seen at rest, bundle fibrillation potential can be seen occasionally, and regular spontaneous motor unit activity potential is the characteristic manifestation of its EMG |
- Citation: Zhang QY, Xu LY, Wang ML, Cao H, Ji XF. Spontaneous conus infarction with "snake-eye appearance" on magnetic resonance imaging: A case report and literature review. World J Clin Cases 2023; 11(9): 2074-2083
- URL: https://www.wjgnet.com/2307-8960/full/v11/i9/2074.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v11.i9.2074