Louise F. Inocentes, BA
Medical Student
Schwab Rehabilitation Hospital
Parkland, Florida, United States
Neneyo Mate-Kole, MD
Resident Physician
Schwab Rehabilitation Hospital
Chicago, Illinois, United States
Raymond Lee, MD
Attending Physician
Schwab Rehabilitation Hospital
Chicago, Illinois, United States
Anterior cord syndrome is caused by hypoperfusion or direct occlusion of the anterior spinal artery or artery of Adamkiewicz, which most commonly originates between T9-T12 and supplies the lower thoracolumbar spinal cord1. They supply the bilateral ⅔ anterolateral spinal cord in the lower containing the corticospinal tracts, spinothalamic tracts, and lateral horns. Ischemia to these tracts cause deficits in motor function, temperature and pain sensation, bowel and bladder continence, respectively1.
Case Description:
50-year-old female with a past medical history of hypertension, hyperlipidemia, type II diabetes, and bipolar disorder developed paralysis and anterior cord syndrome below the T1 vertebrae after sudden PEA arrest. Neuro exam was notable for intact cranial nerve function. Manual Muscle Testing revealed 5/5 muscle strength on upper extremities except 4/5 with shoulder abduction and 0/5 in bilateral lower extremities. ASIA impairment scale revealed intact sensation to light touch to T1, intact pinprick sensation to T5, no sensation to light touch at S4-S5, no voluntary anal contraction, no deep anal pressure, and a notable anal wink reflex. Lower extremities were flaccid and joint position was preserved at 1st MTPs bilaterally.
Discussions:
Given that the artery of Adamkiewicz creates an anastomosis with the anterior spinal artery between T9-T12, this region is a watershed infarct area and has a high association with lower thoracolumbar ischemia1. The cervical and upper thoracic regions have more segmental radicular arteries that should minimize risk for ischemia. This was not the case in our patient, who suffered an atypical presentation of anterior cord syndrome with paraplegia at T1 after cardiac arrest of unknown etiology. Possible etiologies for our patient’s cardiac arrest were ruled out with diagnostic evaluation, including pulmonary embolism, mesenteric ischemia, coronary artery disease, ischemic heart disease, hemorrhagic and ischemic stroke.
Conclusions:
Further research of anterior cord syndrome in the upper thoracic region is warranted.
