Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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August 26, 2013
Spinal Cord Infarction
- Uncommon disease with poor outcome (1–2% of all central neurovascular events). There are different vascular syndromes identified: the anterior spinal artery syndrome (most common, especially in the thoracolumbar cord), posterior spinal arteries syndrome, transverse infarction of the spinal cord, central cord infarction, and venous infarction.
- Clinical presentation varies depending on the vascular territory involved. In most cases, sensory features (particularly pain) emerge first, followed by weakness within minutes or hours.
- Etiology: vascular compression, hypoperfusion, embolism, prothrombotic disorders
- Key Diagnostic Features: There are four patterns:
- Hyperintensity restricted to anterior horns of central gray matter on T2WI (owl eyes pattern)
- Hyperintensity in anterior and posterior horns of central gray matter
- Hyperintensity in anterior and posterior horns of central gray and adjacent central white matter
- Diffuse intramedullary hyperintensity, with or without peripheral sparing
- DDx: Demyelinating, infectious, metabolic and toxic myelopathies; intramedullary tumors
- Rx: There is no specific treatment, and care is generally supportive in nature.