Abstract Details

Title Acute Quadriplegia Secondary to Patent Foramen Ovale-associated Cervical Spinal Cord Infarct

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-024

Objective To describe spontaneous spinal cord infarct (SCI) in the setting of deep vein thrombosis (DVT) and patent foramen ovale (PFO).

Background SCIs constitute <1% of acute ischemic strokes and ~6% of acute myelopathies. Spontaneous SCI has been defined as an ischemic event occurring without an apparent triggering factor, e.g. trauma or medical procedures. Although the etiology of this condition is unclear, case reports suggest a potential link to PFO.

Design/Methods N/A

Results We present a 64-year-old female with a history of hypertension, obstructive sleep apnea, and morbid obesity who developed acute numbness, paresthesiae and weakness of the right arm while driving, progressing to the right leg and then the left side of her body within seconds. She pulled over, honked the horn, and Emergency Medical Services were notified. In the Emergency Department, she had flaccid quadriplegia with areflexia and a C4 sensory level. Magnetic resonance imaging of neuraxis showed 3 small acute brain infarcts (right nodulus, left occipital cortex, right thalamus) and a C2-C6 longitudinal lesion with restricted diffusion. She had taken 4 commercial flights and 2 long-distance drives in the 10 days prior to her presentation. Venous ultrasound showed acute DVT in the right lower extremity on Day 3 of her hospitalization. Transesophageal echocardiogram revealed an aneurysmal interatrial septum and a PFO with a small shunt at rest. Valsalva was not attempted. Exhaustive diagnostic workup including digital subtraction angiography, computerized tomography of chest, abdomen and pelvis, cerebrospinal fluid studies, hypercoagulable tests, infectious and rheumatologic studies did not reveal other potential etiologies. Her RoPE score was only 5 but in the setting of concurrent DVT her PASCAL classification is PFO-probable stroke. She was treated with anticoagulation and PFO closure

Conclusions Paradoxical embolism is one of the pathophysiologic mechanisms of spontaneous SCI. Investigations for PFO and DVT should be considered when this condition is encountered.

Authors/Disclosures
Rafail A. Chionatos, MD (Tufts Medical Center) PRESENTER	Dr. Chionatos has nothing to disclose.
Camelia Valhuerdi Porto, MD (Tufts Medical Center)	Dr. Valhuerdi Porto has nothing to disclose.
Aleksandra Yakhkind, MD (Tufts Medical Center)	Dr. Yakhkind has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LangAware. Dr. Yakhkind has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Yakhkind has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Round Table Group. Dr. Yakhkind has received research support from Sara's Wish Foundation Global Health Grant. Dr. Yakhkind has received publishing royalties from a publication relating to health care. Dr. Yakhkind has a non-compensated relationship as a Faculty with Massachusetts General Hospital CME that is relevant to AAN interests or activities.
David E. Thaler, MD, PhD, FAAN (Tufts Medical Center)	Dr. Thaler has nothing to disclose.

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