Diffusion tensor tractography demonstration of partially injured spinal cord tracts in a patient with posttraumatic Brown Sequard syndrome

The authors report the utility of diffusion tensor tractography in demonstrating the partially severed spinal cord tracts on one side with normal, intact, distally traceable tracts on the opposite side in a patient with posttraumatic Brown Sequard syndrome. A 30-year-old man presented with typical clinical features of a hemisection injury of the thoracic spinal cord, 2 months after he had sustained a back stab injury. Routine MRI showed T2 hyperintense zones in the thoracic spinal cord at the level of T5. We did axial single shot echo planar diffusion tensor imaging with a 1.5 Tesla MR machine. Tractography effectively depicted the injured spinal cord tracts on the left side with normal intact tracts on the right side, which could be traced distally. The fractional anisotropy and apparent diffusion coefficient values showed significant changes at the level of injury. Tractographic demonstration of human spinal cord injury is reported for the first time.