Spinal cord infarction with abdominal aorta atherosclerosis and distal aortic dissection
Presentation
Sudden onset of bilateral lower limb weakness and urine retention.
Patient Data
Longitudinal area of T2 high signal intensity involving predominantly the anterior aspect of the lower thoracic and lumber spinal cord extending from the level of D8 until the level of conus medullaris, with no significant cord expansion.
Diffuse atherosclerotic changes of the abdominal aorta with focal ectasia affecting the distal part of the abdominal aorta just above the level of bifurcation containing intimal flab representing distal abdominal aortic dissection.
Incidental horseshoe kidney.
Case Discussion
Spinal cord infarction is an uncommon condition that causes sudden paralysis, sensory loss, and urinary and bowel dysfunction. The incidence of spinal cord infarction is 1% that of cerebral infarction. The etiology of spinal cord infarction may be idiopathic (36%), a complication of aortic surgery (25%), a consequence of systemic arteriosclerosis (19%), or attributable to aortic dissection or aortic aneurysm (8%). Rare causes include cardiac embolism, decompression sickness, coagulopathy, spinal arteriovenous malformation, fibrous cartilaginous embolism, epidural anesthesia, sickle cell disease, vasculitis, and medication. Embolism of the artery of Adamkiewicz is also a possible etiology. It often causes thoracolumbar medullary infarction.
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