Anterior spinal artery syndrome due to fibrocartilaginous embolism – case report and treatment options
Christian Menke, Ivonne Wieland, Sabine Illsinger, Eva Bültmann, Hans Hartmann
Introduction: Acute occlusion of the anterior spinal artery and subsequent spinal ischemic infarction lead to anterior spinal artery syndrome, characterized by back pain, bilateral flaccid paresis with loss of protopathic sensibility, whilst epicritic sensibility is usually preserved. Besides other causes, fibrocartilaginous embolism associated with sports or unusual strain has been described. Case report: Following extensive gym wheel exercise the day before symptom onset, an 11 y.o. girl presented with neck pain, paresthesia and paresis of both arms and legs and impaired deep tendon reflexes on left sided limbs. She was unable to lift her arms, grasp, stand or walk, and had urinary incontinence. MRI revealed extensive longitudinal hyperintense T2 signal in the anterior spinal cord from C3-C6 with accompanying diffusion restriction involving gray matter at the level of C4 and C5. The adjacent annulus fibrous of the intervertebral disc showed a fissure without disc protrusion. Treatment with prednisolone and enoxaparin was started within 12 hours of beginning of symptoms and continued over 6 days and 8 weeks, respectively. On follow-up her motor function and bladder control gradually improved and after 5 months, there was only slight residual impairment affecting elevation and abduction of the right arm. Conclusion: The patient suffered from acute anterior spinal cord ischemia with imaging findings in line with a presumed fibrocartilaginous embolism. Unlike cases published in the literature, our patient showed almost complete recovery following treatment with prednisolone and enoxaparin. We speculate that the positive outcome may be related to the rapid treatment initiation.
Keywords: spinal stroke, MRI
Christian Menke
Hannover Medical School
Germany
Ivonne Wieland
Hannover Medical School
Germany
Sabine Illsinger
Hannover Medical School
Germany
Eva Bültmann
Hannover Medical School
Germany
Hans Hartmann
Hannover Medical School
Germany
Introduction: Acute occlusion of the anterior spinal artery and subsequent spinal ischemic infarction lead to anterior spinal artery syndrome, characterized by back pain, bilateral flaccid paresis with loss of protopathic sensibility, whilst epicritic sensibility is usually preserved. Besides other causes, fibrocartilaginous embolism associated with sports or unusual strain has been described. Case report: Following extensive gym wheel exercise the day before symptom onset, an 11 y.o. girl presented with neck pain, paresthesia and paresis of both arms and legs and impaired deep tendon reflexes on left sided limbs. She was unable to lift her arms, grasp, stand or walk, and had urinary incontinence. MRI revealed extensive longitudinal hyperintense T2 signal in the anterior spinal cord from C3-C6 with accompanying diffusion restriction involving gray matter at the level of C4 and C5. The adjacent annulus fibrous of the intervertebral disc showed a fissure without disc protrusion. Treatment with prednisolone and enoxaparin was started within 12 hours of beginning of symptoms and continued over 6 days and 8 weeks, respectively. On follow-up her motor function and bladder control gradually improved and after 5 months, there was only slight residual impairment affecting elevation and abduction of the right arm. Conclusion: The patient suffered from acute anterior spinal cord ischemia with imaging findings in line with a presumed fibrocartilaginous embolism. Unlike cases published in the literature, our patient showed almost complete recovery following treatment with prednisolone and enoxaparin. We speculate that the positive outcome may be related to the rapid treatment initiation.
Keywords: spinal stroke, MRI
Christian Menke
Hannover Medical School
Germany
Ivonne Wieland
Hannover Medical School
Germany
Sabine Illsinger
Hannover Medical School
Germany
Eva Bültmann
Hannover Medical School
Germany
Hans Hartmann
Hannover Medical School
Germany
Hans Hartmann
Hannover Medical School Germany
Hannover Medical School Germany