Spinal Cord infarction (SCI) involving para spinal muscles and vertebral bodies are uncommon. We present a case of a patient with SCI who developed sudden onset sharp lower back pain, weakness, and urinary retention and subsequently found to have involvement of paraspinal muscles and vertebral bodies.

Case Description

A 60 years old male with past medical history of diabetes and hypertension presented to the hospital with acute onset of progressive lower extremity weakness and paresthesia, bowel and bladder incontinence, and loss of sensation in his pelvis. MRI brain was unremarkable. MRI spine showed diffusion restriction and enhancement in the distal spinal cord.  Additionally, there was abnormal signal and enhancement involving the T11 and T12 vertebral bodies and abnormal signal in the adjacent muscles. Extensive work up was done including CT body, lumbar puncture, muscle biopsy, and ultimately a spinal angiogram. Infection and malignancy were ruled out, and a vascular etiology was deemed the culprit. The patient recovered majority of his strength, sensation, and bowel and bladder control during hospitalization. He was discharged with aspirin, atorvastatin, and recommendations for physical therapy and lifestyle modifications. At follow-up clinic visit, he was stable with only mild numbness of his plantar feet bilaterally.

SCI is rare and a diagnosis of exclusion, requiring the rule out of other mimickers. Atypical presentations, including patchy sensory or pure motor presentations, are well-described depending on level of cord involved, presence of collateral circulation, and underlying etiology. However, this case is unique due to the triad of bone infarction, conus medullaris infarction, and myositis. The unusual constellation of clinical and radiological findings that we describe here may be useful for clinicians in helping to distinguish SCI from alternate causes of myelopathy.