• Pakistan
• Radiology
• Spinal cord
• Spinal cord infarct

• DWI
• MRI
• aorta
• dissection
• owl’s eyes
• periprocedural
• spinal cord infarction
• time

• non-invasive neuromodulation
• paraplegia
• physical therapy
• spinal cord infarction
• spinal cord injury
• spinal cord stroke
• transcutaneous spinal cord stimulation

• diagnosis
• neurological manifestations
• rehabilitation
• spinal cord diseases
• stroke

• Humans
• Adult
• Male
• Female
• Infarction
• Follow-Up Studies
• Spinal Cord/blood supply
• Spinal Cord/diagnostic imaging
• Anticoagulants/therapeutic use
• Recovery of Function

• : spinal cord infarction
• anterior spinal cord infarction
• owl's eye sign
• owl-eye appearance
• position sense
• sensory impairment
• vibration sense

• Infarction
• Sildenafil
• Spinal cord

• Aged
• Humans
• Male
• Infarction/chemically induced
• Infarction/diagnostic imaging
• Magnetic Resonance Imaging
• Phosphodiesterase 5 Inhibitors/adverse effects
• Sildenafil Citrate/adverse effects
• Spinal Cord/diagnostic imaging

• chest pain
• hypertriglyceridemia
• insulin perfusion
• paraplegia
• spinal cord infarction

• Cauda equina
• DWI
• Lesion distribution
• Spinal cord arteries
• Spinal cord infarction
• Vertebral body infarction

• Humans
• Male
• Female
• Retrospective Studies
• Middle Aged
• Infarction/diagnostic imaging
• Infarction/pathology
• Magnetic Resonance Imaging/methods
• Spinal Cord/diagnostic imaging
• Spinal Cord/blood supply
• Spinal Cord/pathology
• Aged
• Adult
• Spinal Cord Ischemia/diagnostic imaging

• ischemic myelopathy
• spinal cord infarction
• spinal cord ischemia

• STROKE

• Region Stockholm

• infarction
• outcome
• paraplegia
• spinal cord
• thrombolysis

• inflammatory pseudotumor
• magnetic resonance imaging
• myelopathy
• neoplasms
• spinal cord

• Anterior spinal artery syndrome
• Spinal anesthesia
• Spinal cord infarction

• Mimic
• Neoplasia
• Spine
• Tumor

• NEUROLOGY
• Stroke
• Stroke medicine

• Humans
• Quality of Life
• Risk Factors
• Ischemia
• Ischemic Attack, Transient
• Research Design
• Systematic Reviews as Topic

• adolescent
• anterior spinal artery syndrome
• fibrocartilaginous embolism
• oman
• spinal cord infarction

Infarction of the conus medullaris is a rare form of spinal cord infarction. The first symptom is usually acute non-characteristic lumbar pain, followed by lower limb pain, saddle numbness, fecal incontinence, and sexual dysfunction. Spontaneous conus infarction with "snake-eye appearance" on magnetic resonance imaging has rarely been reported.

We report a 79-year-old male patient with spontaneous conus infarction who had acute lower extremity pain and dysuria as the first symptoms. He did not have any recent history of aortic surgery and trauma. Magnetic resonance imaging revealed a rare "snake-eye appearance." In addition, we reviewed the literature on 23 similar cases and summarized the clinical features and magnetic resonance manifestations of common diseases related to the "snake-eye sign" to explore the etiology, imaging findings, and prognosis of spontaneous conus infarction.

We conclude that acute onset of conus medullaris syndrome combined with "snake-eye appearance" should be strongly suspected as conus medullaris infarction caused by anterior spinal artery ischemia. This special imaging manifestation is helpful in the early diagnosis and treatment of conus infarction.

• Spinal cord disease
• Infarction
• Paralysis
• Dysuria
• Magnetic resonance imaging
• Case report

• cervical
• cobra-eyes
• myelopathy
• outcome
• spine
• surgery

• infarction
• postpartum
• spinal cord

• REHABILITATION
• STROKE

Spinal cord infarction (SCI) is a neurological emergency associated with high rates of persistent neurological deficits. Knowledge about this rare but potentially treatable condition needs to be expanded.

To describe the characteristics of spontaneous SCI in a large retrospective series of patients treated at two tertiary care centers in Austria.

We performed a descriptive and comparative analysis of spontaneous SCI treated at the University Hospitals of Salzburg and Graz between the years 2000 and 2020. The analysis included pre- and in-hospital procedures, clinical presentation, etiology, diagnostic certainty, reperfusion therapy, and functional outcome at discharge.

We identified 88 cases, 61% were ascertained in the second half of the study period. The median age was 65.5 years [interquartile range (IQR) = 56–74], 51.1% were women. Anterior spinal artery infarction was the predominant syndrome (82.9%). Demographics, vascular comorbidities, and clinical presentation did not differ between the centers. The most frequent etiology and level of diagnostic certainty were distinct, with atherosclerosis (50%) and definite SCI (42%), and unknown (52.5%) and probable SCI (60%) as front runners in Salzburg and Graz, respectively. Patients arrived after a median of 258.5 min (IQR = 110–528) at the emergency room. The first magnetic resonance imaging (MRI) of the spinal cord was performed after a median of 148 min (IQR = 90–312) from admission and was diagnostic for SCI in 45%. Two patients received intravenous thrombolysis (2.2%). The outcome was poor in 37/77 (48%).

Demographics, clinical syndromes, and quality benchmarks for spontaneous SCI were consistent at two Austrian tertiary care centers. Our findings provide the foundation for establishing standards for pre- and in-hospital care to improve outcomes.

Spinal cord infarction (SCI) is a catastrophic neurologic deficit following spine surgery. Because of the opposite management regimens used for SCI and acute epidural hematoma, accurate diagnosis of SCI is of great importance to maximally reserve neurologic functions and improve outcomes. A 21-year-old man developed acute paralysis and sensory deficits of the bilateral lower limbs shortly after undergoing two-stage combined posterior and anterior multilevel en bloc corpectomy. An emergency second-look surgery revealed wide-spectrum blackness of the thecal sac with no signs of an epidural hematoma. The patient underwent anticoagulation therapy, ventilation support, microcirculation perfusion, and fluid optimization. He regained an ambulatory status without other severe complications. Upon discharge, his muscle strength had returned to grade 4 and his Eastern Cooperative Oncology Group performance score had decreased to 0. At the final 48-month follow-up, the implants were in good position without local recurrence, and the patient was able to lead an independent life and work in his full capacity. An epidural hematoma did not appear to be the cause of SCI after spinal tumor surgery in this case; however, SCI was a possible reason for the acute paralysis. Anticoagulation treatment with adjuvant therapies may be an effective option in managing SCI.

• Spinal cord infarction
• anticoagulation therapy
• case report
• epidural hematoma
• second-look surgery
• spinal tumor

The cervical anterior spinal artery (ASA) is a very important artery arising from the intracranial vertebral artery (VA). It can play different roles in endovascular treatment (EVT) of spinal vascular diseases. The current understanding of these roles is incomplete; therefore, we performed this review. We found that cervical ASA can be involved in many spinal vascular diseases, such as arteriovenous fistula (AVF), arteriovenous malformation (AVM), and aneurysm, and can serve as a collateral channel in proximal VA occlusion. In AVF and AVM, when the cervical ASA is involved, it often plays the role of an accomplice or victim because it acts as the feeder or as a bystander that does not provide blood flow to the AVF and AVM. In cervical ASA aneurysm, the ASA is a victim. During EVT of VA aneurysms or stenoses, the cervical ASA ostia can be covered or occluded, resulting in ASA ischemia. In this situation, the ASA is a victim. In VA occlusion or the subclavian steal phenomenon, the cervical ASA can serve as a collateral channel to provide blood flow to the posterior circulation. In this case, the ASA plays the role of a friend. According to the role of the cervical ASA in spinal vascular diseases, EVT should be determined “case by case.” Most importantly, when EVT is performed to treat these diseases, the cervical ASA axis must be preserved. Therefore, understanding the role of the cervical ASA in spinal vascular diseases is crucial.

• arteriovenous fistula
• arteriovenous malformation
• cervical anterior spinal artery
• endovascular treatment
• vascular disease

Aortic dissection (AD) is a serious condition that causes transient or permanent neurological problems that include spinal cord ischemia (SCI), which occurs when AD extends into the descending aorta resulting in insufficient perfusion of segmental arteries that supplies the spinal cord. We report a 64-year-old male, presented with severe back pain, asymmetrical paresthesia, and weakness of both limbs, more in the left lower limb with loss of pinprick, temperature, and fine touch sensation on the lower left lower limb below the level of T5 with preserved proprioception and vibration and urine hesitancy. Computed tomography showed AD, Stanford type A, and spinal magnetic resonance imaging (MRI) showed hyperintense owl's eye sign at T5. The patient was diagnosed as anterior spinal artery syndrome secondary to an AD and referred for aortic surgical repair with good functional outcome. In our review to cases of SCI due to AD, it was more common in males above 55 years, pain only found in 47.8% of patients, with anterior cord syndrome on top of the clinical presentations, and hypertension is the most common risk factor. MRI spine showed thoracic location predominance. Surgical or endovascular repair especially for type A and complicated type B should be considered to avoid complications, and cerebrospinal fluid drainage is a very useful tool in reversing SCI specially if done early with favorable outcome. Only the old age is associated with increased risk of mortality. Early diagnosis and appropriate management are crucial for better outcome.

• Aortic dissection
• Spinal cord ischemia

• Gene mutation
• Genetic counseling
• Hypercoagulable state
• Spinal cord infarction
• Young adult

• Cauda equina syndrome
• Conus medullaris
• Conus medullaris infarction
• Conus medullaris stroke
• Spinal cord infarction

• Aortic dissection
• Ischaemic spinal cord injury
• Magnetic resonance imaging
• Postoperative
• Thoraco-abdominal aneurysm

• Acute flaccid myelopathy
• Arteriovenous malformation
• Artery of Adamkiewicz
• Dural fistula
• Epidural abscess
• Hematomyelia
• Myelopathy
• Spinal cord infarction

• Acute Disease
• Central Nervous System Vascular Malformations/complications
• Communicable Diseases/complications
• Humans
• Infarction/diagnosis
• Infarction/etiology
• Infarction/therapy
• Male
• Spinal Cord/blood supply
• Spinal Cord Diseases/diagnosis
• Spinal Cord Diseases/etiology
• Spinal Cord Diseases/therapy

• immunology
• spinal cord

Spinal cord infarction is a rare but severe disorder, consistently less frequent than ischemic brain injury. It constitutes only 1-2% of all neurological vascular emergencies. Here we describe a case of spinal cord infarction in a 68-year-old Caucasian man without any neurological problem in his clinical history. The patient presented to the Emergency Department complaining for sudden onset of lower limbs weakness, as well as pain and mild loss of sensitivity in both legs. These symptoms suddenly arose after a 10 minutes bicycle race. He underwent a CT angiography, which confirmed the presence of a fusiform aneurysm of infra-renal abdominal aorta with thrombotic apposition on right lateral side and some ulcerated thrombi. As such, the patient underwent a spinal cord Magnetic Resonance Imaging, that showed images compatible with an acute ischemic injury (infarction) from D11 to medullary cone. He was then treated with low molecular weight heparin, aspirin, and methylprednisolone, and was then admitted to the Stroke Unit. He gradually regained lower limbs sensitivity totally, but the strength was only partially restored. Although a rare entity, Emergency Physicians should always keep in mind this possibility when evaluating patients with sudden loss of sensitivity and/or strength in their lower limbs. (www.actabiomedica.it)

• Diameter
• Infants
• Neonates
• Normal
• Spinal canal
• Spine
• Ultrasound

• Cerebrovascular disease
• Spinal cord disorders
• Spinal cord infarction
• Sulcal artery syndrome
• Vertebral artery dissection

• Aorta
• Magnetic resonance imaging
• Spinal Infarct
• Spinal cord

• Diffusion tensor imaging
• Geometric distortions
• Spatial resolution
• Spinal cord
• White matter integrity

Spinal cord infarction (SCI) is rare, difficult to diagnose, and often fails to be detected by diffusion-weighted imaging (DWI) of spinal cord magnetic resonance imaging (MRI). Because the clinical features of SCI can vary widely, diagnosis during the acute phase of SCI is often challenging for clinicians. Although SCI shares similar etiologies with cerebral infarction, the characteristics of SCI without vessel dissection remain largely unknown. We present two older patients with mild neurological symptoms who each presented with a small, unilateral, upper cervical cord lesion, which was detected by thin-section, coronal DWI of brain MRI. Both unilateral small lesions were localized in the right lateral funiculus, and each patient showed good prognosis. The anatomical findings suggested that the pial collateral network surrounding the cervical cord contributed to lesion formation. Small and localized lesions have been associated with mild neurological symptoms and better short-term prognosis. The present report indicated that the use of thin-section coronal DWI when performing brain MRI may be helpful for the diagnosis of small, unilateral, upper cervical cord infarctions.

• Abdominal aortic thrombosis
• Gray matter
• Spinal cord infarction
• autopsy

• ASIA grade
• abdominal aortic aneurysm
• epidemiology
• etiology
• outcomes
• spinal cord infarct
• spinal cord injury
• spinal cord ischemia

• Anterior spinal artery syndrome
• Complication
• Deformity
• Spine surgery

• Brown-Sequard syndrome
• Fibrocartilaginous embolism
• Spinal cord infarction
• Stroke

Spontaneous conus medullaris infarction is a rare disease. We describe two patients with spontaneous conus medullaris infarction presenting as acute cauda equina syndrome and their unique electromyography (EMG) findings.

Two patients developed acute low back pain with mild asymmetric paraparesis, loss of perianal sensation and sphincter dysfunction. Ankle deep tendon reflexes were reduced in bilaterally. Neither patient had cardiovascular risk factors. Magnetic Resonance imaging showed infarction in the conus medullaris. Functional recovery was good in both patients, but progressive asymmetric calf wasting and sphincter dysfunction remained. EMG studies at follow-up of at least 3 years demonstrate active denervation at the muscles innervated by the first sacrum anterior horn cells.

Spontaneous conus medullaris infarction can occur in healthy individuals and presents as cauda equina syndrome. Findings of needle EMG studies indicate a progressive course of sacrum anterior horn cell disorder during long-term follow-up.

• Cauda equina syndrome
• Conus medullaris infarction
• Electromyography
• Spinal cord infarction