1103 - Atherosclerotic Risk Factors Leading to Spinal Cord Infarction

85-year-old female with history of hypertension, hyperlipidemia, type 2 diabetes mellitus, NSTEMI, 20 pack-year smoker who suddenly experienced bilateral lower extremity weakness and numbness when ambulating. Hypertensive to 188/65 on presentation and reported noncompliance to home medications. She had complete loss of motor and all sensory modalities below T12, urinary retention, and bowel incontinence. CT and MRI of the entire spine were without spinal cord compression; however, MRI showed T2 hyperintensity at T10-12. CSF studies were unremarkable and 5-day steroid course was without benefit. Repeat MRI revealed a central T2 hyperintensity with peripheral sparing extending from T8 to cord terminus and diffusion restriction in the T11 vertebral body. Determined etiology: spinal infarction. TTE was overall unremarkable. ISNCSCI completed: T9 AIS A. By discharge, she required moderate assistance for lower body dressing and maximum assistance for transfers with a slide board. Required, but was independent with, wheelchair mobility to 150 feet.

Discussions:

She had signs of spinal cord injury, however, typical etiologies such as trauma, spinal stenosis with myelopathy, compression, spinal cord tumors, and inflammatory diseases were ruled out. Vascular injury to the spinal cord is more commonly seen with aortic clamping, systemic hypoperfusion, embolic events, and vascular malformations. In this case, her multiple atherosclerotic risk factors predisposed her.

Conclusions: This case highlights the importance of considering spinal cord infarction in the differential diagnosis of acute spinal cord injury, particularly in patients with atherosclerotic risk factors. Although an atypical vascular cause of spinal cord injury, it was a critical consideration in this case as her repeat MRI demonstrated vertebral infarction, as well. Correctly determining the etiology guides prognostication, rehabilitation planning, and helps establish realistic expectations for functional recovery.