Spinal Cord Infarction Mimicking Acute Transverse Myelitis

Area of Science:

• Neurology
• Neuroradiology
• Vascular Neurology

Background:

• Spinal cord infarction (SCI) is a rare cerebrovascular event with nonspecific initial presentations.
• Initial magnetic resonance imaging (MRI) in SCI can be normal or mimic other myelopathies, including acute transverse myelitis (ATM).
• Differentiating SCI from ATM is critical for appropriate management and prognosis.

Observation:

• A 64-year-old male with hypertension presented with acute urinary retention and lower limb weakness.
• Initial MRI and clinical evaluation suggested ATM, but the etiology remained unclear.
• Repeat thoracic spine MRI revealed patchy vertebral body enhancement, indicative of spinal cord and vertebral body infarction.

Findings:

• Spinal cord infarction can present insidiously and be initially misdiagnosed as ATM.
• Vertebral body involvement on MRI is a significant finding suggestive of SCI.
• Serial MRI examinations are essential for accurate diagnosis in suspected cases.

Implications:

• Early and accurate diagnosis of SCI is vital for timely intervention and improved patient outcomes.
• Radiologists and clinicians should consider SCI in the differential diagnosis of acute myelopathies, especially with atypical MRI findings.
• Recognition of vertebral body changes on MRI can aid in differentiating SCI from other spinal cord pathologies.