Arkoudis NA, Karachaliou A, Triantafyllou G, Papadopoulos A, Koutserimpas C, Velonakis G. Spinal cord ischemia: The “snake bite sign”. World J Radiol 2025; 17(7): 110385 [DOI: 10.4329/wjr.v17.i7.110385]
Corresponding Author of This Article
Nikolaos-Achilleas Arkoudis, MD, PhD, Academic Fellow, Consultant, Lecturer, Research Fellow, Researcher, Department of Radiology 2nd, General University Hospital “Attikon”, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari 12462, Attikí, Greece. narkoudis@med.uoa.gr
Research Domain of This Article
Neuroimaging
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Jul 28, 2025; 17(7): 110385 Published online Jul 28, 2025. doi: 10.4329/wjr.v17.i7.110385
Spinal cord ischemia: The “snake bite sign”
Nikolaos-Achilleas Arkoudis, Anastasia Karachaliou, George Triantafyllou, Andreas Papadopoulos, Christos Koutserimpas, Georgios Velonakis
Nikolaos-Achilleas Arkoudis, Anastasia Karachaliou, Andreas Papadopoulos, Georgios Velonakis, Department of Radiology 2nd, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Chaidari 12462, Attikí, Greece
Nikolaos-Achilleas Arkoudis, Georgios Velonakis, Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, Athens 11528, Attikí, Greece
George Triantafyllou, Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Goudi 11527, Greece
Christos Koutserimpas, School of Rehabilitation Health Sciences, University of Patras, Patra 26504, Dytikí Elláda, Greece
Author contributions: Arkoudis NA, Karachaliou A, Triantafyllou G, and Papadopoulos A wrote the main manuscript text and prepared the figure; Arkoudis NA, Koutserimpas C, and Velonakis G assisted with conceptualization and provided supervision; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikolaos-Achilleas Arkoudis, MD, PhD, Academic Fellow, Consultant, Lecturer, Research Fellow, Researcher, Department of Radiology 2nd, General University Hospital “Attikon”, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari 12462, Attikí, Greece. narkoudis@med.uoa.gr
Received: June 5, 2025 Revised: June 19, 2025 Accepted: July 14, 2025 Published online: July 28, 2025 Processing time: 50 Days and 10.9 Hours
Abstract
Descriptive signs in radiology can aid in easier pattern recognition and quicker diagnosis. In spinal cord ischemia, paired anterior-horn T2-hyperintensities have traditionally been known as the “owl’s eyes” or “snake eyes” sign. We discuss how these signs, while visually apt, convey no pathophysiologic context and propose renaming this finding the “snake bite sign”. The image still evokes two punctate marks, yet the metaphor extends to a snake bite (two fang-like dots) rather than two bright foci (eyes) staring back at the viewer. Moreover, besides the sign metaphorically resembling a traumatic puncture of the two fangs, on the occasion of a venomous snake bite occurring elsewhere, additional neurological consequences may occur, paralleling the neurological deficits seen in anterior spinal artery infarction and several mimicking myelopathies, thus further highlighting the analogy. Such clinically driven terminology may facilitate teaching, enable diagnostic recall, and improve interdisciplinary communication.
Core Tip: We propose renaming the “owl’s eyes” or “snake eyes” sign seen in spinal cord pathologies such as ischemia to the “snake bite sign”. This term retains the visual metaphor while adding clinical relevance, as it mirrors both the appearance (two fang-like dots) and neurological consequences of an elsewhere occurring venomous snake bite. It enhances educational impact and diagnostic clarity in spinal cord pathology, especially anterior spinal artery infarction when symmetrical anterior-horn hyperintensities appear.
