Spinal cord infarction. A case report and narrative review

Main Article Content

Federica Pigna
Silvia Lana
Carlotta Bellini
Laura Bonfanti
Michele Creta
Gianfranco Cervellin

Keywords

spinal cord infarction; spinal cord ischemia; paraparesis; magnetic resonance imaging; MRI; emergency department

Abstract

Spinal cord infarction is a rare but severe disorder, consistently less frequent than ischemic brain injury. It constitutes only 1-2% of all neurological vascular emergencies. Here we describe a case of spinal cord infarction in a 68-year-old Caucasian man without any neurological problem in his clinical history. The patient presented to the Emergency Department complaining for sudden onset of lower limbs weakness, as well as pain and mild loss of sensitivity in both legs. These symptoms suddenly arose after a 10 minutes bicycle race. He underwent a CT angiography, which confirmed the presence of a fusiform aneurysm of infra-renal abdominal aorta with thrombotic apposition on right lateral side and some ulcerated thrombi. As such, the patient underwent a spinal cord Magnetic Resonance Imaging, that showed images compatible with an acute ischemic injury (infarction) from D11 to medullary cone. He was then treated with low molecular weight heparin, aspirin, and methylprednisolone, and was then admitted to the Stroke Unit. He gradually regained lower limbs sensitivity totally, but the strength was only partially restored. Although a rare entity, Emergency Physicians should always keep in mind this possibility when evaluating patients with sudden loss of sensitivity and/or strength in their lower limbs.

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References

1. Vargas MI, Gariani J, Sztajzel R et al. Spinal cord ischemia: practical imaging tips, pearls and pitfalls. Am J Neuroradiol 2015;36:825-830
2. Cheshire WP, Santos CC, Massey EW, Howard JF Jr. Spinal cord infarction: etiology and outcome. Neurology 1996;47:321-330
3. Novy J, Carruzzo A, Maeder P, et al. Spinal cord ischemia: clinical and imaging patterns, pathogenesis and outcomes in 27 patients. Arch Neurol 2006;63:1113-1120
4. Cheng MY, Lyu RK, Chang YJ et al. Spinal cord infarction in Chinese patients. Clinical features, risk factors, imaging and prognosis. Cerebrovasc Dis 2008;26:502-508
5. Weidauer S, Nichtweiß M, Hattingen E, et al. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology. 2015;57:241-257
6. Wong JJ, Dufton J, Mior SA. Spontaneous conus medullaris infarction in a 79 year-old female with cardiovascular risk factors: a case report. J Can Chiropr Assoc 2012;56:58-65
7. Melissano G, Civilini E, Bertoglio L et al. Angio-CT imaging of the spinal cord vascularization: a pictorial essay. Eur J Vasc Endovasc Surg 2010;39:436-440
8. Mullen MT, McGarvey M. Spinal cord infarction: clinical presentation and diagnosis. Up to date, last accessed April 17th, 2019
9. Wachowski M, Polguj M, Scibor J et al. Ischemia of the medullary cone after stent-graft implantation in a patient with abdominal aortic aneurysm - a case study. Wideochir Inne Tech Maloinwazyjne. 2018;13:116-121
10. Masson C, Pruvo JP, Meder JF et al. Spinal cord infarction: clinical and magnetic resonance imaging findings and short term outcome. J Neurol Neurosurg Psychiatry 2004;75:1431-1435
11. Ross JS, Brant-Zawadzki M, Moore KR, et al. Diagnostic imaging spine; in Ross JS (ed): Spinal Cord Infarction. Salt Lake City, Amirsys, 2004, pp 26–29