Abdel-Mannan and Mahmud Journal of Medical Case Reports 2011, 5:31 http://www.jmedicalcasereports.com/content/5/1/31 Page 3 of 4 Figure 2 Sagittal T2-weighted MRI scan showing an abnormally high signal of the spinal cord extending from C3 down to the lower end plate of C5. secondary to dissection of a distal vertebral artery. He was started on 300 mg aspirin, and his case was reviewed by both a physiotherapist and a diabetic specialist nurse while he was an in-patient. Within three days of presen- tation, power in both of his arms had improved (MRC score 4/5), except for abduction of his right shoulder, which he could not lift above the horizontal position. Spinal cord infarction and ischemia are rare and often difficult to diagnose, but they represent important differ- ential diagnoses of acute spinal symptoms. This case presentation describes an interesting presentation of ASCIS which differs from the classically described symptoms, insofar as the patient had no clinically detectable sensory deficit. This disorder is also asso- ciated with significant morbidity and mortality. In this case, the prognosis was favorable. This led us to a review of the literature on the prognosis and outcome of acute spinal cord ischemia. Discussion The standard drug therapy for ASCIS is aspirin, which is based upon the medical recommendation for acute treatment of ischemic stroke of any type. In addition, clopidogrel and a combination of aspirin and controlled- release dipyridamole may be of benefit in reducing the risk of recurrent stroke and death [9]. A number of stu- dies have explored both prognosis and recovery of patients with ASCIS, with the aim of identifying the fac- tors that influence spinal cord infarction outcome (see Table 1). Salvador de la Barrera et al. [10] conducted a retrospective study of 36 patients with vascular spinal cord ischemia in which symptom severity was graded according to the American Spinal Injury Association (ASIA)/International Medical Society of Paraplegia (IMSOP) criteria. Assessment of functional outcome was based on wheelchair use or ambulatory ability. The initial severity of symptoms was identified as the stron- gest predictor of outcome, and this has been confirmed by further studies [11,12]. Those patients lacking Table 1 Summary of various prognosis and outcome studies on spinal cord ischemiaa Source Salvador de la Barrera et al. [10] Nedeltchev et al. [6] Cheshire et al. [1] Iseli et al. [12] Patients 36 57 44 28 Mean follow-up 19.9 ± 30 months Neurological syndrome (%) ASAS (100) 4.5 ± 4 years 1.2 ± 2 years ASAS (67) PSAS (3) BSS (18) CSCT (12) No data 6 months No data Severity of initial motor deficit (%) ASIA A (19.4) ASIA B (27.8) ASIA C (30.6) ASIA D (19.4) ASIA A (12) ASIA B (18) ASIA C (28) ASIA D (42) Paraplegia (57) Paraperesis (41) ASIA motor score (mean) 57.22 Outcome (%) Full walking ability (18) Walk with aids (25) Wheelchair user (57) Dead (22.2) Full walking ability (41) Walk with aids (30) Wheelchair user (20) Dead (9) Full walking ability (11) Walking with aids (27) Wheelchair user (44) Dead (18) Full walking ability or ability to walk with aids (25) Abbreviations: ASIA American Spinal Injury Association, ASAS Anterior spinal artery syndrome, PSAS Posterior spinal artery syndrome, BSS Brown-Séquard syndrome, CSCT Complete spinal cord transaction. aAdapted with permission from Nedeltchev et al. [6]. A comparison of the clinical characteristics and outcome measures reported in four different studies on spinal cord ischemia highlighting the large differences between groups and the scarcity of long-term follow-up studies with large sample sizes.