Spectrum of clinicoradiological findings in spinal cord infarction: Report of three cases and review of the literature
A 19-year-old girl presented with history of neck pain followed by acute-onset quadriparesis, which peaked within 2 h, of 15 days duration. Pulse dose steroids were administered elsewhere. On examination, power in the upper limbs was grade 1 bilaterally; the lower limbs had grade 3 power. There was dissociated sensory loss with pain and temperature being lost below the C4 level, proprioception was preserved. MRI [] showed a long-segment signal abnormality in the anterior aspect of the cervical cord from C3 to C6 level, with mild expansion and patchy enhancement.\nDiagnosis of anterior spinal artery (ASA) infarct was considered. Other differentials included myelitis and demyelination. CSF analysis including viral markers was negative. Visual-evoked potentials, echocardiogram, MR angiogram of the aortic arch and cerebral vessels were normal. The cANCA titers were found to be elevated (28.2, normal range less than 15). There was no hematuria or proteinuria to suggest renal involvement. Nerve conduction studies were noncontributory.\nConsidering the high specificity of cANCA, the possibility of immune-mediated disease with SCI was considered. As steroids were already administered, it was decided to keep her under follow-up considering the fact that she was improving. Further immunomodulation was deferred as she had a urinary tract infection. At 6-week follow-up, there was significant improvement in motor power.