Sean Goldman, D.O.
Resident Physician
University of Miami
Boca Raton, Florida, United States
Ethan Goldman, D.O.
Resident Physician
Florida Atlantic University
Boca Raton, Florida, United States
Anterior Cord Syndrome in a Patient with HIV and Syphilis Myelitis
Case Description:
A 45-year-old male with a history of HIV and untreated syphilis presented with sudden onset of lower extremity weakness, bowel and bladder dysfunction, and loss of pain and temperature sensation below the umbilicus. Neurological examination revealed motor paralysis and a complete loss of pain and temperature sensation below the thoracic level, while proprioception and vibration sense were preserved.
Initial imaging, including MRI of the spine, suggested myelitis with possible anterior cord involvement. However, further investigations, including chest CT and echocardiography, identified a massive saddle embolus in the pulmonary artery and right ventricular strain. The patient’s symptoms were attributed to hypoperfusion of the spinal cord due to the compromised hemodynamics associated with the pulmonary embolism.
Discussions: This case highlights a rare intersection of conditions leading to anterior cord syndrome. The patient’s underlying HIV and syphilis myelitis likely predisposed him to spinal cord vulnerability. The acute presentation of anterior cord syndrome was secondary to hypoperfusion affecting the watershed area of the thoracic spine, particularly the region supplied by the anterior spinal artery and the artery of Adamkiewicz. This watershed area, more susceptible to ischemia, was compromised by the saddle embolus and associated right ventricular strain. Such hypoperfusion exacerbates neurological deficits in individuals with preexisting myelitis or spinal cord pathologies.
Conclusions:
In patients with complex conditions such as HIV and syphilis myelitis, it is crucial to consider additional complications that may compound neurological symptoms. This case underscores the importance of a comprehensive diagnostic approach when facing unexpected neurological deterioration, especially in the context of cardiovascular complications. Early identification and management of contributing factors such as HIV, syphilis, pulmonary embolism can significantly impact patient outcomes and guide effective treatment strategies.
