Journal of General Internal Medicine

, Volume 22, Issue 1, pp 151–154 | Cite as

Spinal Cord Infarction with Multiple Etiologic Factors

  • John J. MillichapEmail author
  • Bernard T. Sy
  • Rodney O. Leacock
Case Reports/Clinical Vignettes


Spinal cord infarction is uncommon and usually presents with sudden onset of paralysis and sensory disturbances. A variety of causes are described, but rarely with multiple factors involved. We report a case of a 63-year-old man with a history of diabetes mellitus, hypertension, and osteoarthritis who presented with acute onset of chest pain, numbness, and weakness associated with episodic hypotension. He had incomplete tetraplegia and was areflexic without spasticity. Pain and temperature sensations were impaired below the C7 dermatome and absent below the T4 dermatome bilaterally. Proprioception and vibration sensations were diminished on the right below the C6 dermatome. Magnetic resonance imaging showed spinal cord infarction affecting C6–T3 segments, and severe cervical and lumbar spine degenerative changes. This case illustrates an unusual presenting symptom of spinal infarction, the need to identify multiple risk factors for spinal cord infarction, and the importance of optimal preventive therapy in patients at risk.

Key words

spinal cord infarction anterior spinal artery preventive medicine 



This case was previously presented in part during the poster session at the Scientific Meeting of the North Carolina Chapter of the American College of Physicians (ACP) on February 17, 2006 in Durham, North Carolina.

Potential Financial Conflicts of Interest

None disclosed.


  1. 1.
    Masson C, Pruvo JP, Meder JF, et al. Spinal cord infarction: clinical and magnetic resonance imaging findings and short term outcome. J Neurol Neurosurg Psychiatr. 2004;75:1431–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Salvador de la Barrera S, Barca-Buyo A, Montoto-Marques A, Ferreiro-Velasco ME, Cidoncha-Dans M, Rodriguez-Sotillo A. Spinal cord infarction: prognosis and recovery in a series of 36 patients. Spinal Cord. 2001;39:520–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Goetz CG. Textbook of Clinical Neurology, Second Edition. Philadelphia: Saunders; 2003:273–4, 401–02,417.Google Scholar
  4. 4.
    Cheshire WP, Santos CC, Massey EW, Howard JF Jr. Spinal cord infarction: etiology and outcome. Neurology. 1996;47:321–30.PubMedGoogle Scholar
  5. 5.
    Ishizawa K, Komori T, Shimada T, et al. Hemodynamic infarction of the spinal cord: involvement of the gray matter plus the border-zone between the central and peripheral arteries. Spinal Cord. 2005;43:306–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Kim JS, Ko SB, Shin HE, Han SR, Lee KS. Perioperative stroke in the brain and spinal cord following an induced hypotension. Yonsei Med J. 2003;44:143–5.PubMedGoogle Scholar
  7. 7.
    Okuno S, Touho H, Ohnishi H, Karasawa J. Cervical infarction associated with vertebral artery occlusion due to spondylotic degeneration: case report. Acta Neurochir (Wien). 1998;140:981–5.CrossRefGoogle Scholar
  8. 8.
    Ram S, Osman A, Cassar-Pullicino VN, Short DJ, Masry WE. Spinal cord infarction secondary to intervertebral foraminal disease. Spinal Cord. 2004;42:481–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Suzuki K, Meguro K, Wada M, Nakai K, Nose T. Anterior spinal artery syndrome associated with severe stenosis of the vertebral artery. AJNR Am J Neuroradiol. 1998;19:1353–5.PubMedGoogle Scholar
  10. 10.
    Parent A. Carpenter’s Human Neuroanatomy, Ninth Edition. Baltimore: Williams & Wilkins; 1996:93–6.Google Scholar
  11. 11.
    Suzuki T, Kawaguchi S, Takebayashi T, Yokogushi K, Takada J, Yamashita T. Vertebral body ischemia in the posterior spinal artery syndrome: case report and review of the literature. Spine. 2003;28:E260–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Cheshire WP Jr. Spinal cord infarction mimicking angina pectoris. Mayo Clin Proc. 2000;75:1197–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Combarros O, Vadillo A, Gutierrez-Perez R, Berciano J. Cervical spinal cord infarction simulating myocardial infarction. Eur Neurol. 2002;47:185–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Pashkovskoya I, Smith CE. Spinal cord infarction and paraplegia after peripheral vascular surgery with spinal anesthesia. J Clin Anesth. 2004;16:440–4.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • John J. Millichap
    • 1
    • 3
    Email author
  • Bernard T. Sy
    • 1
  • Rodney O. Leacock
    • 2
  1. 1.Departments of Internal Medicine and PediatricsBrody School of Medicine at East Carolina UniversityGreenvilleUSA
  2. 2.East Carolina Neurology, Inc.GreenvilleUSA
  3. 3.Medicine-Pediatrics Residency Program, Brody School of MedicineEast Carolina UniversityGreenvilleUSA

Personalised recommendations