Imaging Characteristics, Clinical Presentation, and Prognosis of Spinal Cord Infarction

Spinal cord infarction is a rare neurological disorder, and its clinical features, imaging findings, and prognostic factors remain incompletely understood. This retrospective cohort study aimed to comprehensively evaluate the clinical presentation, magnetic resonance imaging (MRI) characteristics, and functional prognosis of patients with spinal cord infarction. We analyzed 19 patients diagnosed with spinal cord infarction at multiple institutions in Japan between 2012 and 2022. Clinically, infarctions were classified into anterior spinal artery (ASA) syndrome (n =12), Brown-Séquard syndrome (n =5), and transverse infarction (n =2). A favorable prognosis, defined as independent ambulation at discharge, was observed in six patients, five of whom presented with Brown-Séquard syndrome, indicating a significant association between this phenotype and better functional outcomes. In contrast, ASA syndrome and transverse infarction were more frequently associated with poor prognosis. All patients demonstrated hyperintensity at the infarcted site on T2-weighted MRI during follow-up. Among eight patients who underwent diffusion-weighted imaging (DWI) within two days of symptom onset, five showed early hyperintensity, suggesting the usefulness of DWI for early diagnosis. The etiology of infarction, including iatrogenic and non-iatrogenic causes, was not significantly related to neurological outcome. These findings suggest that early DWI may facilitate prompt diagnosis of spinal cord infarction and that the infarction pattern, rather than etiology, is an important determinant of functional prognosis.