1252 - Posterior cord syndrome of vascular origin: a case report

A 67-year-old female presented with a 1-year history of mechanical low back pain. In the week prior to hospitalization, she had a sudden exacerbation of pain, dysesthesias in lower limbs, gait disturbance, weakness, and urinary incontinence. Clinical evaluation revealed hypoesthesia to fine touch, pain, and vibration at the T9 medullary level; gait alteration by ataxia, instability, positive Romberg, bilateral knee hyperextension during stance phase, and right foot drop during swing. Muscle strength was normal in all 4 limbs, without hyporeflexia or altered tone.

Nutritional deficiencies and infectious etiologies were ruled out. Brain MRI was normal. Sensory and motor nerve conductions of the lower limbs were normal. Prolonged latencies were found in the responses of the somatosensory-evoked potentials of the lower limbs. Dorsal and lumbosacral MRI with and without contrast showed degenerative changes without spinal cord alteration or spinal mass. Vascular etiology was considered.

Discussions:

The patient participated in an interdisciplinary rehabilitation program, with continuous assessments (such as the chair to stand test, the up and go test, the short physical performance battery and the spinal cord independence measure III), showing clinical and objective improvement in balance and gait tests. She regained independence using assistive devices and compensatory visual reinforcement due to the alteration in sensory feedback.

Conclusions: Posterior cord syndrome, with an incidence of approximately 1%, is a rare cause of gait disturbances, frequently associated with patients over 60 years. The involvement of an interdisciplinary team, early rehabilitation, and the application of functional tests and prognostic factors lead to optimal functional outcomes.