Abdel-Mannan and Mahmud Journal of Medical Case Reports 2011, 5:31 http://www.jmedicalcasereports.com/content/5/1/31 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access A patient presenting with intact sensory modalities in acute spinal cord ischemia syndrome: a case report Omar Abdel-Mannan1*†, Imran Mahmud2† Abstract Introduction: Acute spinal cord ischemia syndrome is a rare condition comprising a small fraction of neurovascular accidents, the majority of which occur within the cerebral circulation. The circulation of the spinal cord has several unique features that determine the clinical presentation. Case presentation: In this case of a 67-year-old Caucasian man who came to our emergency department with sudden-onset, severe right-sided pain and bilateral upper limb weakness, an atypical pattern of sensory deficit was observed. In this case report, we review acute spinal cord ischemia syndrome and consider the pathophysiology, diagnostic measures and prognostic factors associated with patient recovery. Conclusion: Acute spinal cord ischemia syndrome with atypical patterns of sensory deficit is uncommon. Clinicians must consider acute spinal cord ischemia syndrome when assessing all patients with acute neck pain and focal neurological deficits; atypical presentations can present a diagnostic challenge. Current knowledge of the long- term outcome in patients with spinal cord ischemia is based on only a few small studies, some of which are discussed here. Introduction Spinal cord infarction, or death of a macroscopic region of tissue in the spinal cord, is a rare event. Estimates report spinal cord infarction comprising only 1.2% of all strokes and an overall annual incidence of only 12 per 100,000. The pattern of symptoms can predict the vas- cular territory affected during the ischemic episode [1]. Acute spinal cord ischemia syndrome (ASCIS) is predic- tably due primarily to pathology in the anterior spinal artery, its feeders or its branches. First described by Spil- ler in 1909 [2], thrombosis of the anterior spinal artery is often due to fracture of a cervical vertebra or a cervi- cal hyperextension injury. Vascular disease risk factors are present in 50% of patients, and no clear etiological cause is identified in as many as half of patients [3]. In this case study, the patient’s spinal cord infarction is likely to have resulted from atherosclerotic changes in the spinal cord vasculature because of our patient’s vas- cular risk factors. * Correspondence: abdelmannan87@gmail.com † Contributed equally 1St John’s College, St Giles, Oxford OX1 3JP, UK Full list of author information is available at the end of the article The spinal circulation comprises two paired posterior spinal arteries running down the dorsum of the cord and a single anterior artery found in the median fissure. Up to eight radicular arteries are established during development and supply the anterior spinal artery, the largest of which is the artery of Adamkiewicz between T9 and T11. Mid-thoracic levels are most vulnerable to ischemia (for example, as a result of thrombosis) as there is only one radicular artery supplying the anterior spinal artery in this region, and sparse anastomoses. Extensive collateral circulation tends to protect the pos- terior arterial territories from vascular disease. The hallmarks of acute spinal cord infarction are a sud- den, apoplectic onset of severe back or neck pain (50-80% of cases) accompanied by paraparesis or paraplegia [4]. The territory of the anterior spinal artery covers the ante- rolateral and corticospinal tracts, but not the dorsal col- umns. The classic presentation for anterior spinal artery ischemia or infarct is sensory deficits in the following pattern: distal to the lesion, pain and temperature are lost bilaterally (owing to the involvement of anterolateral spi- nothalamic tracts), but light touch, vibration and position sense are preserved (owing to sparing of dorsal columns). Muscle weakness (involvement of the corticospinal tract) © 2011 Abdel-Mannan and Mahmud; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.