Magnetic resonance imaging and diffusion-weighted imaging findings in posterior spinal cord infarction: Case report

Abstract

Acute spinal cord ischemia (SCI) accounts for 5%e8% of all acute myelopathies [1]. In the SCI, posterior spinal artery (PSA) syndrome is much less common than in anterior spinal artery (ASA) syndrome [2], with PSA accounting for 3% of all acute SCIs and ASA syndrome accounting for 67% [3]. In 1994, Kaneki et al. provided a case report review of 27 cases of PSA syndrome in the literature [2]. Essentially, all 27 cases were diagnosed from neurological findings and the exclusion of other pathological conditions by neuroimaging. Even MRI cannot easily detect acute ischemic lesions in PSA syndrome due to their small size and changes in the signal that occur over the disease course. Diffusion-weighted imaging (DWI) is a well-established diagnostic method for acute cerebral ischemic injury [4] and is a potential tool for the detection of SCI. Among cases of SCI detected by DWI, ASA infarction was more involved than PSA infarction [5e7]. On the other hand, the proportion of PSA infarction among cases of SCI detected by DWI may be high than that among cases diagnosed by clinical sign, although there are only three reports on PSA infarction detected by DWI [5,8,9]. Here, we report clinical and imaging findings in a case of PSA infarction, including time-dependent changes of the apparent diffusion coefficient (ADC) abnormality, and propose that time