Abstract
IntroductionAcute spinal cord ischemia syndrome is a rare condition comprising a small fraction of neurovascular accidents, the majority of which occur within the cerebral circulation. The circulation of the spinal cord has several unique features that determine the clinical presentation.Case presentationIn this case of a 67-year-old Caucasian man who came to our emergency department with sudden-onset, severe right-sided pain and bilateral upper limb weakness, an atypical pattern of sensory deficit was observed. In this case report, we review acute spinal cord ischemia syndrome and consider the pathophysiology, diagnostic measures and prognostic factors associated with patient recovery.ConclusionAcute spinal cord ischemia syndrome with atypical patterns of sensory deficit is uncommon. Clinicians must consider acute spinal cord ischemia syndrome when assessing all patients with acute neck pain and focal neurological deficits; atypical presentations can present a diagnostic challenge. Current knowledge of the long-term outcome in patients with spinal cord ischemia is based on only a few small studies, some of which are discussed here.
Highlights
ConclusionAcute spinal cord ischemia syndrome with atypical patterns of sensory deficit is uncommon
Acute spinal cord ischemia syndrome is a rare condition comprising a small fraction of neurovascular accidents, the majority of which occur within the cerebral circulation
Clinicians must consider acute spinal cord ischemia syndrome when assessing all patients with acute neck pain and focal neurological deficits; atypical presentations can present a diagnostic challenge
Summary
This case report demonstrates an interesting and unique presentation of ASCIS. We observed an unexpected pattern of sensory deficits. Rather than the classical pattern comprising loss of pain and temperature sensation distal to the lesion, with sparing of vibration and position sense, in our patient we detected intact sensory modalities in all dermatomes tested. Our patient had preserved muscle function at the onset of symptoms (with only temporary weakness), which is predictive of a good outcome as shown in the aforementioned prognostic studies. Spinal cord infarction is often serious, leading to paraplegia or even death, and requires prompt diagnosis; our patient was fortunate and suffered only mild disability, and he is currently continuing physiotherapy for further rehabilitation. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images.
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