Abstract
Clinical features of cervical spontaneous spinal cord infarctions (SSCIs) remain poorly
described in the literature. The goal of this article was to improve recognition of
cervical SSCI, a rare but life-threatening condition. We presented a 15-year-old adolescent
male patient who developed neck pain with weakness and numbness in all four limbs
half an hour after returning from a hike in the late afternoon. The next morning,
he was brought to the emergency room due to persistent weakness, vomiting, and progressive
respiratory distress. He was promptly intubated for airway protection. Pupils were
2 mm, sluggishly reactive, and all four extremities were flaccid. He was found to
have anterior spinal cord syndrome. Light touch (brush) was normal down to the posterior
aspect of shoulders. Cervical magnetic resonance imaging (MRI) showed increased T2/short-tau
inversion recovery and decreased T1 signal of the anterior spinal cord from C3 to
C7. Four days later, MRI of the spinal cord showed restricted diffusion of anterior
spinal cord consistent with radicular artery territory infarction. The work-ups for
infection, thrombosis, and cardioembolism were all negative. Three months later, he
still had incomplete Brown-Séquard's syndrome, as position sense was preserved. There
was in addition bilateral loss of pain and temperature sensations below the clavicles.
MRI showed cervical myelomalacia most severe between C3 and C5. Furthermore, MRI showed
changes in C3–C4 intervertebral disc, consistent with a fibrocartilaginous embolism
via retrograde arterial route into the anterior spinal artery. This article demonstrates
the importance of recognizing subtle clinical clues leading to cervical SSCI diagnosis.
Keywords pediatric - cord atrophy - Horner's syndrome - vomiting
