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Magnetic resonance imaging of acute infarction of the anterior spinal cord

1998; BMJ; Volume: 64; Issue: 2 Linguagem: Inglês

10.1136/jnnp.64.2.279

1468-330X

Àlex Rovira, Salvador Pedraza, Manuel Comabella, JoAnn Alvarez, António J. Salgado,

Aortic Disease and Treatment Approaches

Infarction in the territory supplied by the cervical anterior spinal artery occurs infrequently, especially in young people. The anterior spinal artery supplies the ventral two thirds of the spinal cord and provides its major blood supply. In the cervical cord, the anterior spinal artery is supplied by anterior radicular arteries arising from the cervical branches of the vertebral arteries and the ascending cervical arteries.1 There have been few reports of MRI in the first hours after the start of an anterior spinal artery syndrome. We describe a case of an acute anterior spinal cord syndrome appearing after two suppressed sneezes that was studied with MRI only four hours after the onset of symptoms. A 37 year old previously healthy woman suddenly experienced severe anterior thoracic pain after two consecutive suppressed sneezes. Five minutes later, the pain irradiated to the arms and was followed by paresthesiae and weakness in both upper limbs. One hour later the weakness and paresthesiae had extended to the legs. On admission neurological examination showed tetraparesis, with a predominantly distal motor deficit in the arms (0/5 power distal and 3/5 proximal). There was an overall reduction in power to 3/5 in the legs. The deep tendon reflexes were diminished in the arms and absent in the legs. Plantar responses were indifferent. There was a loss of sensation for pain and temperature below the T2 dermatome. Light touch and vibratory and position sensitivity were preserved. The patient also developed a neurogenic bladder. With these the clinical features, an infarction in the territory of the anterior spinal artery was suspected and an emergency MRI of the cervical spine was performed four hours after the onset of symptoms. This initial MRI, …