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Abstract Details

Spinal Cord Ischemia in a Young Patient Following Strenuous Exercise
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (5:30 PM-6:30 PM)
6-027
NA
Spinal infarcts in the setting of anatomical variants with absent arteries of Lazorthes and Adamkiewicz are rare and seldom reported.

We report a healthy twenty-two-year-old man who presented after severe neck pain following strenuous weight lifting, with bilateral arm followed by leg weakness, and respiratory failure requiring intubation. Initial exam was significant for absent movement in the arms and decreased movement in the left > right leg, a C3 sensory level, and hyporeflexia. 

MRI cervical/thoracic/lumbar spine with and without gadolinium revealed an extensive, thin, anterior, non-enhancing T2 hyperintensity from the craniocervical junction to T7. CSF analysis was unremarkable. He was started on steroids and plasmapheresis for possible NMOSD though anterior spinal artery infarct was high in the differential. Repeat MRI was DWI positive with ADC correlate. A spinal angiogram revealed the absence of intracranial vertebral artery, PICA, a. of Lazorthes, and a. of Adamkiewicz. Steroids and plasmapheresis were discontinued after anti-MOG and NMO antibodies were negative. 
This patient’s presentation exemplifies the challenge of determining whether the underlying etiology is demyelinating versus ischemic. Given that the patient's symptoms developed in the setting of strenuous weight lifting, the diagnosis of spinal cord infarct is likely. The most probable mechanism is dissection and occlusion of the vertebral artery with subsequent occlusion of the anterior spinal artery. The anatomic variants seen in the spinal angiogram may have worsened the presentation due to fewer collaterals present. Another mechanism which was considered, although less likely, was fibrocartilaginous embolism. During the hospital course the patient regained motor function in the legs and some function in the arms but continued to require mechanical ventilation.
Acute intramedullary ischemia should be considered in younger patients without vascular risk factors if the clinical presentation and diagnostic work-up are suggestive, even when a thrombus or dissection is not seen on angiogram. 
Authors/Disclosures
Sonia S. Bellara, MBBS (SUNY Downstate Medical University)
PRESENTER 		Dr. Bellara has nothing to disclose.
Robert S. Sacks, MD (SUNY Downstate Medical Center) Dr. Sacks has nothing to disclose.
Hyunah Choi, MD (SUNY Downstate) Dr. Choi has nothing to disclose.
Elizabeth Chernyak, MD (Maimonides Medical Center) Dr. Chernyak has received research support from Maimonides Research and Development Foundation . Dr. Chernyak has received research support from 好色先生 .
Nuri Jacoby, MD, FAAN Dr. Jacoby has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Jacoby has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for N/A.
Steven Levine, MD, FAHA (SUNY Downstate Medical Center) Dr. Levine has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MEDLINK. Dr. Levine has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Law Firms. The institution of Dr. Levine has received research support from NIH.