Cervicomedullary hematoma: diagnosis by MR.

CT is often useful for diagnosing primary or secondary brainstem hematoma. However, subacute hemorrhage may be isodense with the normal brain substance, causing a false negative CT study. MR tends to be positive during this phase of hemorrhage. We present an unusual case of an intramedullary hematoma that was not detected by CT but was detected by MR. MR has shown great promise as a neuroradiologic tool in difficult situations by virtue of its excellent tissue-contrast resolution, a lack of bone artifacts, and direct multiplanar imaging capability [1]. The lack of signal from bone has the advantage that neighboring brain structures, particularly those in the posterior fossa, are not obscured by the linear bone artifacts common to CT scans [2] . Primary hemorrhages of the brain stem commonly involve the pons, less frequently the cerebral peduncle, and rarely, the medulla oblongata [3] . Primary bulbar hemorrhage is usually first identified at autopsy. To our knowledge, there is no known reported case of cervicomedullary hematoma in which antemortem diagnosis was established by any imaging technique. In our case, CT failed to show the lesion but MR clearly identified the hematoma. Timely surgical intervention with evacuation of the hematoma resulted in marked postoperative functional recovery.