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Case Reports
. 2023 Jun 30;9(2):107-111.
doi: 10.4103/bc.bc_80_22. eCollection 2023 Apr-Jun.

An ischemic myelopathy case series: Flaccid paraplegia following a spike ball save and numbness while walking normally

Caroline A Heckman  1 , Derryl J Miller  2 , Kelly M Kremer  3 , Mesha L Martinez  4 , Andrew H Jea  5
Affiliations
Case Reports

An ischemic myelopathy case series: Flaccid paraplegia following a spike ball save and numbness while walking normally

Caroline A Heckman et al. Brain Circ. .

Abstract

Spinal cord infarctions in children are rare and early magnetic resonance imaging studies are often negative. A high clinical suspicion must be maintained to identify stroke and initiate workup for underlying etiology to suggest appropriate treatment. We present two cases of spinal cord infarction without major preceding trauma. The first was caused by disc herniation and external impingement of a radiculomedullary artery and the second was due to fibrocartilaginous embolism with classic imaging findings of ventral and dorsal cord infarctions, respectively. These cases were treated conservatively with diagnostic workup and aspirin, though additional treatments which can be considered with prompt diagnosis are also explored in our discussion. Both cases recovered the ability to ambulate independently within months. Case 1 is attending college and ambulates campus with a single-point cane. Case 2 ambulates independently, though has some difficulty with proprioception of the feet so uses wheelchairs for long-distance ambulation.

Keywords: Artery of Adamkiewicz; fibrocartilaginous embolism; radiculomedullary artery; stroke; surfer’s myelopathy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
MRI Thoracic Spine without and with gadolinium contrast performed 3 days after symptom onset. (a) Noncontrast sagittal T1 Thoracic Spine MRI: Arrowheads show superior border of multilevel Schmorl’s nodes. (b) Postgadolinium sagittal T1 Thoracic Spine MRI: Arrowheads show posterior border of faint enhancement of the anterior spinal cord. (c) Noncontrast sagittal Thoracic Spine T2 MRI: Arrowheads show corresponding edema of the anterior cord from T5 to T8. (d) Noncontrast Axial Thoracic Spine T2 MRI: Arrows show edema of the anterior cord in the distribution of the ASA at the levels of T5 and T6. MRI: Magnetic resonance imaging, ASA: Anterior Spinal Artery
Figure 2
Figure 2
Digital subtraction angiography of the spine. (E1) Catheterization of left T8 intersegmental artery. (E2) Contrast reveals a prominent radiculomedullary artery, a duplicate AA2 with severely decreased contrast opacification of both AA2 and the ASA. (F1) Catheterization of left L1 intersegmental artery. (F2) Contrast reveals prominent radiculomedullary artery, the AA1 with robust contrast opacification and normal filling of the ASA. ASA: Anterior Spinal Artery, AA1: Artery of Adamkiewicz 1, AA2: Artery of Adamkiewicz 2
Figure 3
Figure 3
MRI Thoracic spine without gadolinium contrast performed 3 weeks after symptom onset. (g) Noncontrast sagittal T1 Thoracic Spine MRI, (h) Noncontrast sagittal Thoracic Spine T2 MRI: arrows show edema of the dorsal cord inferior to T10, (i) Noncontrast axial T1 Thoracic Spine MRI, (j) Noncontrast axial T2 Thoracic Spine MRI: arrow shows edema of the dorsal cord at T11. MRI: Magnetic resonance imaging
See this image and copyright information in PMC

References

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