Introduction Sudden-onset quadriplegia is a neurologic emergency that requires immediate management. Anterior spinal artery syndrome (ASAS) is rare, but can cause sudden-onset quadriplegia. Magnetic resonance imaging (MRI) is an essential imaging modality for diagnosing ASAS. Case Presentation A 31-year-old woman without previous medical history was transferred to our facility for further workup of sudden-onset neck pain with quadriplegia. Diffusion-weighted imaging (DWI) revealed hyperintense signals predominantly in grey matter with a decreased apparent diffusion coefficient (ADC). These findings strongly suggested ASAS with spinal cord infarction. Edaravone, heparin, and aspirin with steroid pulse therapy were immediately initiated. Twelve days in an intensive care unit was required for dyspnea. Symptoms gradually resolved with rehabilitation, but the patient was wheelchair-bound without bladder control and was transferred to a rehabilitation facility on hospital day 48. Conclusion A combination of DWI with ADC mapping of the spine should proceed as soon as possible to ensure appropriate management. Early treatment with edaravone, aspirin, and steroid pulse therapy may prove beneficial for ASAS.

Introduction: Sudden-onset quadriplegia is a neurologic emergency that requires immediate management. Anterior spinal artery syndrome (ASAS) is rare, but can cause sudden-onset quadriplegia. Magnetic resonance imaging (MRI) is an essential imaging modality for diagnosing ASAS.Case presentation: A 31-year-old woman without previous medical history was transferred to our facility for further workup of sudden-onset neck pain with quadriplegia. Diffusion-weighted imaging (DWI) revealed hyperintense signals predominantly in grey matter with a decreased apparent diffusion coefficient (ADC). These findings strongly suggested ASAS with spinal cord infarction. Edaravone, heparin, and aspirin with steroid pulse therapy was immediately initiated. Twelve days in an intensive care unit was required for dyspnea. Symptoms gradually resolved with rehabilitation, but the patient was wheelchair-bound without bladder control and was transferred to a rehabilitation facility on hospital day 48.Conclusion: A combination of DWI with ADC mapping of the spine should proceed as soon as possible to ensure appropriate management. Early treatment with edaravone, aspirin and steroid pulse therapy may prove beneficial for ASAS.

A 77-year-old man presented to the emergency room with a 1-month history of persistent low back pain with the absence of vital sign abnormalities. On several previous orthopedic surgery clinic visits, pathological back pain had not been considered and pain killers had been prescribed because he had low back pain due to lumbar spinal canal stenosis. He was admitted to the intensive care unit for infectious spondylodiscitis and infective endocarditis with disseminated abscess caused by methicillin-resistant Staphylococcus aureus. Shock refractory tachyarrhythmia could not be managed with antiarrhythmic agent in the intensive care unit. Intractable low back pain and persistent tachyarrhythmia were adequately managed by pain control with fentanyl in the intensive care unit. Infectious spondylodiscitis and infective endocarditis were effectively managed with anti–methicillin-resistant Staphylococcus aureus drugs, initially in rotational usage, but the patient died of extended-spectrum beta-lactamase-producing Escherichia coli pneumonia on day 50 of hospitalization. Infectious spondylodiscitis should have been considered for persistent low back pain with hemodialysis, fever, and a history of device implantation. Pain management may be necessary for persistent tachycardia that proves unresponsive to usual antiarrhythmic medications.

Hippocampal infarction is relatively rare. Many different diseases can mimic hippocampal infarction including transient global amnesia, Alzheimer’s disease, epilepsy, encephalitis, and encephalopathies. An 89-year-old man was transported to our hospital for altered consciousness. Diffusion-weighted magnetic resonance imaging revealed slightly intense signals in the hippocampus with a mildly decreased apparent diffusion coefficient. Serial magnetic resonance imaging revealed features of hippocampal infarction. Symptoms and cognitive function gradually improved with rehabilitation, and he was transferred to a rehabilitation facility on Hospital Day 38. Hippocampal infarction is rare in patients with altered mental status, but should be considered when magnetic resonance imaging shows findings suggestive of this condition. Other differential diseases should be ruled out by serial magnetic resonance imaging and observation of the clinical course.