Spectrum of clinicoradiological findings in spinal cord infarction: Report of three cases and review of the literature
A 58-year-old gentleman presented with sudden-onset severe low back pain noted while lifting the shutter of a shop, followed by feeling of heaviness and weakness of both lower limbs. The deficits peaked by 1 h, with urinary retention and decreased sensation below the mid abdomen. Clinical examination revealed asymmetric paraparesis, Medical Research Council (MRC) scale power grade 2 on the right and grade 3 on the left lower limb. There were absent lower limb deep tendon reflexes, bilateral extensor plantars and impaired propioception below the T7 level. Blood pressure and peripheral pulses were normal. Overall features were suggestive of myelopathy at the T7 level.\nClinical possibilities considered included intervertebral disc prolapse, SCI due to fibrocartilagenous embolism (FCE), aortic dissection, vascular malformation with bleed and inflammatory or infectious myelitis. Magnetic resonance imaging (MRI) [Figures and ] revealed T2W and STIR hyperintensity extending from the T7 to the T11 level, with relative sparing of the anterior surface of the cord and no contrast enhancement. There was associated marrow edema in the posterior aspect of D10 vertebral body. The cerebrospinal fluid (CSF) analysis was noncontributary. Computerized tomography (CT) angiogram did not reveal any atheromatous plaques or dissection.\nConsidering the diagnosis of posterior spinal artery (PSA) infarction, conservative treatment was started. Motor power improved and he was ambulant by 8 weeks. Follow-up scan done 8 months later [] showed only a subtle posterior column hyperintensity with volume loss; the T10 vertebra was still showing fat replacement along the posterior margin.