Spinal Cord Ischemia Secondary to Aortic Dissection: Case Report with Literature Review for Different Clinical Presentations, Risk Factors, Radiological Findings, Therapeutic Modalities, and Outcome

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.

Young Woman with Sudden-Onset Neck Pain and Quadriplegia: a Case Report

Introduction Sudden-onset quadriplegia is a neurologic emergency that requires immediate management. Anterior spinal artery syndrome (ASAS) is rare, but can cause sudden-onset quadriplegia. Magnetic resonance imaging (MRI) is an essential imaging modality for diagnosing ASAS. Case Presentation A 31-year-old woman without previous medical history was transferred to our facility for further workup of sudden-onset neck pain with quadriplegia. Diffusion-weighted imaging (DWI) revealed hyperintense signals predominantly in grey matter with a decreased apparent diffusion coefficient (ADC). These findings strongly suggested ASAS with spinal cord infarction. Edaravone, heparin, and aspirin with steroid pulse therapy were immediately initiated. Twelve days in an intensive care unit was required for dyspnea. Symptoms gradually resolved with rehabilitation, but the patient was wheelchair-bound without bladder control and was transferred to a rehabilitation facility on hospital day 48. Conclusion A combination of DWI with ADC mapping of the spine should proceed as soon as possible to ensure appropriate management. Early treatment with edaravone, aspirin, and steroid pulse therapy may prove beneficial for ASAS.

Anterior Spinal Artery Syndrome due to Intervertebral Disc Herniation: A systematic review

Objective: Anterior spinal artery syndrome (ASAS) has been rarely reported as a complication of intervertebral disc herniation (IVDH). Precipitation factors, presentation, evaluation, treatment strategy, and degrees of recovery have not yet been well documented. Methods: Systematic review was conducted according to PRISMA guidelines to review and summarize for the qualitative synthesis of the data from reported cases of anterior spinal artery syndrome due to intervertebral disc herniation from 1980 to February 2021. Results: A total of 12 cases were reviewed, the median age was 48.5 years. Motor weakness with or without pain was the most frequent presenting symptom accompanying bowel or bladder incontinence (25%) or diminished pain and temperature sensation with spared dorsal column sensation. 40% of conservatively treated patients had complete recovery without any residual deficit. Whereas all patients who managed surgically regained fully functional status with shorter recovery intervals. Conclusion: Abrupt onset of motor weakness is a potential warning symptom of spinal cord infarction, rarely attributed to ASA compression by a herniated disc. Moreover, an accompanying diminished pain and temperature sensation with spared dorsal column sensation is further intimation. Reestablishment of blood flow may bear a favorable outcome.

A Review on the Pathophysiology and Management of Anterior Spinal Artery Syndrome

As an uncommon cause of spinal cord infarction, anterior spinal cord syndrome can manifest with motor paralysis, loss of pain, and temperature sensation distal to the site of the lesion. The main pathogenesis of this syndrome is the disruption of blood flow in the anterior spinal artery. Mortality and morbidity differ with the etiology of the syndrome. So knowing the etiology of blood flow disruption is essential for patient management. This review article highlights the important clinical manifestation of Anterior spinal artery syndrome. Also describes etiology, pathogenesis, diagnosis, prognosis, possible management, and complications.

Young Woman With Sudden-onset Neck Pain and Quadriplegia: A Case Report

Introduction: Sudden-onset quadriplegia is a neurologic emergency that requires immediate management. Anterior spinal artery syndrome (ASAS) is rare, but can cause sudden-onset quadriplegia. Magnetic resonance imaging (MRI) is an essential imaging modality for diagnosing ASAS.Case presentation: A 31-year-old woman without previous medical history was transferred to our facility for further workup of sudden-onset neck pain with quadriplegia. Diffusion-weighted imaging (DWI) revealed hyperintense signals predominantly in grey matter with a decreased apparent diffusion coefficient (ADC). These findings strongly suggested ASAS with spinal cord infarction. Edaravone, heparin, and aspirin with steroid pulse therapy was immediately initiated. Twelve days in an intensive care unit was required for dyspnea. Symptoms gradually resolved with rehabilitation, but the patient was wheelchair-bound without bladder control and was transferred to a rehabilitation facility on hospital day 48.Conclusion: A combination of DWI with ADC mapping of the spine should proceed as soon as possible to ensure appropriate management. Early treatment with edaravone, aspirin and steroid pulse therapy may prove beneficial for ASAS.