Abdel-Mannan and Mahmud Journal of Medical Case Reports 2011, 5:31 http://www.jmedicalcasereports.com/content/5/1/31 Page 4 of 4 voluntary muscle contraction at admission (ASIA groups A and B) were found to be at a higher risk of needing to use wheelchairs. The degree of pathology found on MRI scans (for example, cord enlargement and high-intensity lesions), however, could not be directly correlated to the severity of the neurological syndrome. Advanced age in patients was also identified as a risk factor for unfavorable functional outcome; the mean age of the walking group was 49.2 years compared to 61.4 years in the wheelchair group. For every year older that patients were at presentation, there was a relative risk of 1.14 of remaining wheelchair-bound. Why is age a factor in determining prognosis? One possible explanation for this is that associated co-morbidities and a gradual dete- rioration in motor learning ability with increased age impede the rehabilitation process, resulting in a poorer outcome. Most of the current studies fail to address long-term out- come in patients with ASCIS. More recently, Nedeltchev et al. [13] conducted a retrospective analysis of 54 patients with a number of ischemic neurological syndromes for a much longer mean follow-up period of 4.5 years to address this question. Clinical improvement and outcome were graded in a similar manner to the study by Salvador de la Barrera et al. [10]. Nedeltchev et al. confirmed, as pre- viously reported [14], that patients with a severe initial motor deficit of ASIA grade A or B had a poorer outcome. However, age, vascular risk factors and time from symptom onset to maximum severity were not found to be signifi- cant predictors of poor prognosis. Conclusion This case report demonstrates an interesting and unique presentation of ASCIS. We observed an unexpected pat- tern of sensory deficits. Rather than the classical pattern comprising loss of pain and temperature sensation distal to the lesion, with sparing of vibration and position sense, in our patient we detected intact sensory modal- ities in all dermatomes tested. Our patient had pre- served muscle function at the onset of symptoms (with only temporary weakness), which is predictive of a good outcome as shown in the aforementioned prognostic studies. Spinal cord infarction is often serious, leading to paraplegia or even death, and requires prompt diag- nosis; our patient was fortunate and suffered only mild disability, and he is currently continuing physiotherapy for further rehabilitation. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Abbreviations ASCIS: Acute Spinal Cord Ischemia Syndrome; MRC: Medical Research Council; ASIA: American Spinal Injury Association; IMSOP: International Medical Society of Paraplegia. Acknowledgements We thank Dr Philip Bejon, consultant in general medicine at the John Radcliffe Hospital, Oxford, for his helpful comments and advice on the case. Author details 1St John’s College, St Giles, Oxford OX1 3JP, UK. 2St Catherine’s College, Oxford OX1 3UJ, UK. Authors’ contributions OA researched and analyzed the literature for the discussion section, which he wrote. IM carried out the research for the Introduction and wrote that section. Both authors contributed to the case report section equally and were involved in the editing of all the other sections. Both authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. 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