Every spinal cord injury includes the possibility that neurological symptoms will remain that threaten to reduce the quality of life considerably. Prompt and well-planned therapy - often surgical - is required in order to prevent these symptoms. Prompt and relevant diagnostic measures are indicated. MR imaging is the diagnostic modality of choice, since traumatic intramedullary lesions can only be visualized with MRI. Moreover, in the acute stage, MRI findings provide important prognostic information. If MRI is available, it should be carried out in all cases when spinal cord injury is suspected despite the problems involved when examining acutely traumatized patients.