Abstract
BackgroundSpinal cord infarction is an uncommon condition. Anterior cord syndrome present with paraparesis or quadriparesis with sparing of vibration and proprioceptive senses. The common causes of anterior cord syndrome are aortic dissection and aortic surgical interventions. Spontaneous unruptured nondissected aortic aneurysms with intramural thrombus can rarely cause anterior cord infarctions.Case presentationWe report a case of anterior spinal cord syndrome due to aneurysm of the thoracic aorta with a mural thrombus. A 64 year old male presented with sudden onset paraparesis with a sensory level at T1 with preserved sense of proprioception and vibration. The MRI panspine revealed increased T2 intensity in the anterior portion of the spinal cord from C5 to T10 level with characteristic ‘owl eye’ appearance on axial imaging. The CT aortogram detected aneurysmal dilatation of the ascending aortic, arch and descending thoracic aorta with significant intimal irregularities, calcified atherosclerotic plaques and a small mural thrombus.ConclusionThe possible mechanisms postulated are occlusion of ostia of radicular arteries by the atherosclerotic plaques and mural thrombus or thromboembolism to the anterior spinal artery. Nondissected atherosclerotic aortic aneurysms should be considered in patients presenting with spinal cord infarctions especially in the presence of vascular risk factors and smoking.
Highlights
Spinal cord infarction is an uncommon condition
Nondissected atherosclerotic aortic aneurysms should be considered in patients presenting with spinal cord infarctions especially in the presence of vascular risk factors and smoking
We present a previously healthy male smoker presenting with anterior spinal cord syndrome, found to be habouring an asymptomatic aneurysm of the arch, ascending and proximal descending aorta with marked atherosclerotic plaques along with a small mural thrombus
Summary
Spinal cord infarction unlike cerebral infarction is an uncommon entity. Anterior spinal cord syndrome is a well known manifestation of aortic dissection necessitating surgical interventions involving the aorta. Spontaneous unruptured abdominal aortic aneurysms causing anterior cord syndromes due to mural thrombi had only rarely been reported. We report this patient as there had been only one case report of unruptured nondissected thoracic aortic aneurysm with mural thrombus presenting as anterior spinal cord syndrome in the literature upto now. The possibility of unruptured atherosclerotic aortic aneurysm with or without mural thrombi should be considered as a cause in patients presenting with spinal cord infarctions especially males, smokers after exclusion of the common aetiologies such as compressive lesions and vasculitides. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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