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Cervical spinal cord infarction in a patient with cervical spondylosis triggered by straining during bowel movement

Yuichiro Ii1, Toshiki Maki, Tomoyuki Furuta

  • 1Department of Neurology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514 8507, Japan. ii-y@clin.medic.mie-u.ac.jp

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|November 18, 2008
PubMed

Insights

A spinal cord infarction initially affecting the left shoulder resolved, but recurred and worsened after straining during defecation, leading to quadriparesis. This event highlights the potential link between straining and anterior spinal artery infarction.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Spinal Cord Medicine

Background:

  • Spinal cord infarction is a rare but severe neurological event.
  • Anterior spinal artery (ASA) territory infarcts can lead to significant neurological deficits.
  • The role of Valsalva-like maneuvers in precipitating spinal cord ischemia is not fully understood.

Observation:

  • An 82-year-old male presented with acute left shoulder pain and hemiparesis, initially resolving.
  • Initial MRI revealed cervical spinal cord compression and ischemia at C3-4.
  • Recurrence of symptoms, progressing to quadriparesis and respiratory compromise, occurred after straining during defecation.

Findings:

  • Follow-up MRI demonstrated a new infarction in the ASA territory (C2-C5).
  • The second ischemic event was potentially triggered by increased venous and intervertebral disc pressure during defecation.
  • This may have caused intraluminal thrombus formation within the ASA.

Implications:

  • Straining during defecation can precipitate or exacerbate spinal cord ischemia, particularly in the ASA territory.
  • Understanding these triggers is crucial for managing patients with spinal vascular conditions.
  • This case underscores the importance of considering vascular events in the differential diagnosis of fluctuating or recurrent spinal cord symptoms.

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