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Clinical-Medical Image - International Journal of Clinical & Medical Images (2022) Volume 9, Issue 9
Author(s): Jihane EL Houssni*, Siham Oukacem, Yahya El Harras, Nada Adjou, Meryem Edderai and Jamal El Fenni
Department of Radiology, Mohammed Vth military hospital, Ryad Street, 10010 Rabat, Morocco
Date of Submission: 12 September, 2022, Manuscript No. ijcmi-22-77733; Editor assigned: 13 September, 2022, 2022, PreQC No. P-77733; Reviewed: 19 September, 2022, QC No. Q-77733; Revised: 22 September, 2022, Manuscript No. R-77733; Published: 30 September, 2022, DOI: 10.4172/2376-0249.1000849
Citation: Houssni JE, Oukacem S, Harras YE, Adjou N and Edderai M et al. (2022) Acute Spinal Cord Infarction: A Case Report. Int J Clin Med Imaging 9:849.
Copyright: © 2022 Houssni JE, et.al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Clinical history
A 62-year-old man without previous pathologic antecedents was admitted to the emergency department for sudden-onset quadriplegia.
Spinal cord MRI: T2 FLAIR weighted sequences in axial (A) and sagittal (B) sections and diffusion sequence (C) shows Intramedullary signal abnormalities at the cervical level opposite C2 in T2 Flair hyper signal (A, B) with diffusion restriction giving the “Owl’s eye” appearance(C) (Figure 1).
Spinal cord ischemia is a rare entity with a poor prognosis [1]; it represents about 6% of all acute myelopathies and about 1 to 2% of all vascularneurological pathologies [2]; it occurs mainly in patients with a cardiovascular background disease [1].
The onset of symptoms is usually abrupt [3], and the clinical presentation depends mainly on the location and extent of the infarction [1,3]. Anterior Spinal Artery Syndrome is the most common; it usually presents as a bilateral loss of motor function and pain/temperature sensation, with relative sparing of proprioception and vibratory senses below the level of the lesion [1]. MRI is the crucial modality in case of suspected acute spinal cord ischemia [3]; it presents as a restriction of diffusion imaging of the spinal cord, hyper intense signal in T2 and STIR, and iso intense signal in T1 [1], a variety of characteristic MRI “signs” have been described:
• Pencil-like: Zone of signal abnormality at the site of ischemia in sagittal T2-weighted MRI [2].
• Sagittal T1-weighted imaging may show segmental cord swelling or focally elevated signal thought to represent haemorrhagic transformation [2].
• Owl’s eye sign: Symmetrical T2 hyper signal abnormality of the anterior horn neurons, very suggestive of the anterior spinal syndrome [2].
• Positive anterior cauda sign: characteristic of thoracolumbar spinal cord ischemia, it translates into an asymmetric enhancement of the anterior nerve roots of the cauda equina [2].
• Compressive myelopathy: Extra spinal tumor, hematoma, abscess, herniated disc
• Infectious myelopathy: HTLV1, HIV, varicella, progressive multifocal leuko encephalopathy (PML)
• Inflammatory or autoimmune myelopathy: transverse myelitis, multiple sclerosis, systemic lupus erythematosus, Devic’s syndrome
• Others: neuromyelitis optica, arteriovenous malformations, porphyria.
Spinal cord infraction; MRI; Owl’s eye sign
[1] Vargas MI, Gariani J, Sztajzel R and Barnaure-Nachbar I et al. (2015) Spinal cord ischemia: practical imaging tips, pearls, and pitfalls. Am J Neuroradiol 36(5): 825-830.
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[2] Caton MT, Huff JS. (2021) Spinal Cord Ischemia. StatPearls Publishing.
[3] Mohr JP, Wolf Philip A, Grotta James C and Moskowitz Michael A et al. (2011) Spinal Cord Ischemia. Stroke (Fifth Edition) 643-657.
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