Abstract
Infarction or ischemia of the spinal cord is a rare entity and is often misdiagnosed as inflammatory myelopathy in acute settings. Atherosclerotic disease can affect spinal arteries, leading to cord ischemia with clinical presentation mixed with myelopathy. We present a case of a 66-year-old male who came to the hospital with unsteady gait and numbness of all extremities without associated pain for the past 48 hours. The neurological examination on admission directed the diagnosis towards myelopathy of the cervical spine. However, the initial magnetic resonance imaging (MRI) of the cervical spine demonstrated gliosis and restricted diffusion of the cord with multilevel neuroforaminal stenosis but without central canal stenosis or cord compression. The MRI brain, cerebrospinal fluid analysis, and rheumatologic evaluation were unremarkable. Four days into the clinical course, the patient developed weakness and spasticity of all extremities prompting further evaluation. Computed tomography angiography (CTA) scan of the head and neck revealed right vertebral artery occlusion and intracranial atherosclerotic disease. He was started on aspirin and clopidogrel for secondary risk reduction. The hospital course was further complicated by Ogilvie syndrome (OS), and the patient underwent uncomplicated cecostomy.
Highlights
Spinal cord ischemia is caused by a vascular interruption that can lead to cord dysfunction, ischemia, and infarction [1]. e blood supply of the spinal cord consists of anterior and posterior spinal arteries. e cervical cord lesions can typically present with either acute quadriparesis or paraparesis. ree vessels arising from vertebral arteries supply the spinal cord in the neck consisting of anterior and two posterior spinal arteries [2]. e manifestation of cord infarction is spontaneous with unknown etiology
We present a unique and first-ever report of cryptogenic cervical cord acute ischemic infarction with late-onset development of Ogilvie syndrome
A 66-year-old male with a past medical history of hypertension, hyperlipidemia, coronary artery disease, prostate cancer, and gastroesophageal reflux disease presented to the emergency department with intermittent symptoms of disequilibrium, gait instability, and progressive numbness of all extremities. e patient developed hypotension and required vasopressors and intravenous fluid support after his neurologic symptomatology further evolved into weakness and spasticity
Summary
Cervical Spine Ischemic Stroke Complicated by Spastic Quadriparesis and Ogilvie Syndrome: A Case Report and Literature Review. Atherosclerotic disease can affect spinal arteries, leading to cord ischemia with clinical presentation mixed with myelopathy. E neurological examination on admission directed the diagnosis towards myelopathy of the cervical spine. Four days into the clinical course, the patient developed weakness and spasticity of all extremities prompting further evaluation. Computed tomography angiography (CTA) scan of the head and neck revealed right vertebral artery occlusion and intracranial atherosclerotic disease. He was started on aspirin and clopidogrel for secondary risk reduction. E hospital course was further complicated by Ogilvie syndrome (OS), and the patient underwent uncomplicated cecostomy He was started on aspirin and clopidogrel for secondary risk reduction. e hospital course was further complicated by Ogilvie syndrome (OS), and the patient underwent uncomplicated cecostomy
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