Vertebral Body Infarction as a Confirmatory Sign of Spinal Cord Ischemic Stroke

Abstract

Background -Acute spontaneous spinal cord syndromes often remain etiologically ambiguous despite extensive diagnostic efforts. In the previous literature five cases are described with acute spinal cord syndromes interpreted as spinal cord ischemic strokes because of association with vertebral body infarctions on MRI. Case Descriptions-Three cases are presented, and the literature is reviewed. In addition to an extensive diagnostic battery including an initial MRI without pathological signs, follow-up MRI at different time intervals from the onset of symptoms showed T2 hyperintense signals in vertebral bodies. Patient 1, who had plaques in the abdominal aorta, had suffered a thoracolumbar spinal infarction; this and a concomitant infarction of the left portion of T-12 could be demonstrated on follow-up MRI on day 12. Patient 2, who had incomplete transverse spinal artery syndrome below T-3, had an abnormal signal at the T-2 level of the spinal cord on follow-up MRI on day 5; this was one segment above infarction of the dorsal area of T-3, corresponding to the ascending course of the medullary artery. The spinal cord of patient 3, who had a posterior spinal artery syndrome below T-11, was unremarkable on follow-up MRI on day 14, but a T2 hyperintense signal was noted in the dorsal area of T-10. Conclusions-Vertebral body infarction represents the only confirmatory sign for the otherwise exclusionary diagnostic procedure for spinal cord ischemic stroke and must be searched for on follow-up MRI as a key to correct diagnosis.(Stroke. 1998;29:239-243.)

Vertebral body infarction indicating midthoracic spinal stroke

“…6 Since there are di culties to conceive of a single pathological process other than a vascular event that can a ect acutely both the spinal cord and the spinal column without a ecting the intervening epidural and subarachnoid spaces these bone marrow hyperintensities on T2-weighted images were interpreted as vertebral body infarctions. 7 Follow-up MRI investigations in our patient revealed vertebral body infarction of Th 9 and Th 10 in their dorsal parts.…”

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“…‘Owl’s eyes’ signs were commonly seen in ASA infarctions, suggesting involvement of the anterior grey matter [7]. Vertebral body infarctions were noted as confirmation signs of SCI [8, 9]. …”

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