Spinal cord ischaemia

Case contributed by Dr Vincent Tatco

Presentation

Back pain with numbness and weakness of the lower extremities.

Patient Data

Age: 75 years old
Gender: Male
MRI

There are increased intramedullary spinal cord signals, predominantly involving the central grey matter, from T8-T9 level down to the conus medullaris on T2-weighted and STIR sequences. In some segments, the abnormal intramedullary signals exhibit an owl's eye appearance. There is some degree of spinal cord expansion. Associated aortic dissection is demonstrated. 

The spine shows degenerative osseous changes. Schmorl's node is seen at the superior endplate of the T11 vertebra. Disc desiccation is noted at T3-T4 and T10-T11 levels. There is multilevel ligamentum flavum hypertrophy with moderate spinal canal narrowing at T10-T11.

Incidentally, there is bilateral pleural effusion and abnormals signals, possibly consolidations and/or atelectasis, in both lungs.

CT

There is dissection of the aorta from the root down to the proximal abdominal aorta just before the origin of the renal arteries (Stanford A, DeBakey type I).  

Other findings:

  • bilateral pleural effusion
  • consolidations and atelectasis in both lungs
  • bilateral renal cysts
  • degenerative osseous changes

Case Discussion

This case shows an example of acute spinal cord ischaema resulting as a complication of aortic dissection. The spinal cord is involved in up to 10 % of the cases of aortic dissection, particularly those involving the descending aorta. This is due to occlusion of the intercostal arteries, artery of Adamkiewicz, or thoracic radicular artery.

 

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Case information

rID: 45707
Case created: 5th Jun 2016
Last edited: 6th Jun 2016
Inclusion in quiz mode: Included

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