Zhang QY, Xu LY, Wang ML, Cao H, Ji XF. Spontaneous conus infarction with "snake-eye appearance" on magnetic resonance imaging: A case report and literature review. World J Clin Cases 2023; 11(9): 2074-2083 [PMID: 36998945 DOI: 10.12998/wjcc.v11.i9.2074]
Corresponding Author of This Article
Xiao-Fei Ji, MD, PhD, Chief Physician, Department of Neurology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian 116011, Liaoning Province, China. jixiaofei1979@163.com
Research Domain of This Article
Neurosciences
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 26, 2023; 11(9): 2074-2083 Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.2074
Spontaneous conus infarction with "snake-eye appearance" on magnetic resonance imaging: A case report and literature review
Qiao-Yu Zhang, Lin-Ying Xu, Ming-Li Wang, Hua Cao, Xiao-Fei Ji
Qiao-Yu Zhang, Lin-Ying Xu, Ming-Li Wang, Hua Cao, Xiao-Fei Ji, Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Qiao-Yu Zhang, Department of Neurology, Nanchuan People's Hospital Affiliated to Chongqing Medical University, Chongqing 408400, China
Author contributions: Zhang QY contributed to manuscript writing and editing, and data collection; Xu LY and Wang ML contributed to data analysis; Cao H and Ji XF contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Fei Ji, MD, PhD, Chief Physician, Department of Neurology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian 116011, Liaoning Province, China. jixiaofei1979@163.com
Received: December 16, 2022 Peer-review started: December 16, 2022 First decision: January 12, 2023 Revised: January 27, 2023 Accepted: March 3, 2023 Article in press: March 3, 2023 Published online: March 26, 2023
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
Core Tip: Infarction of the conus medullaris is a rare form of spinal cord infarction, and there is no specific examination method in clinic. On the other hand, the "Snake-Eye Appearance" on the diffusion-weighted imaging sequence of magnetic resonance imaging highly suggests spinal cord infarction, although few cases of conus infarction have been reported. This special imaging manifestation is helpful in the early diagnosis and treatment of conus infarction.
