Acute to Subacute Spinal Cord Infarction Mimicking Acute Multiple Sclerosis: Usefulness of Diffusion-weighted MRI for Diagnosis

Abstract

Background: Spinal Cord Infarction (SCI) is difficult to diagnose because of its rarity, unknown etiology, and unestablished diagnostic criteria. Additionally, the timeline of SCI has not been studied in detail, as few studies using Diffusion-Weighted Image (DWI) sequences of the spine of a small target population have been previously conducted.

Case study: A 56-year-old male with underlying arrhythmia suddenly developed visual field defects on the right side, pain in the left upper extremity, and a tingling sensation in the left hand. Brain Magnetic resonance imaging (MRI) revealed acute to subacute stages of multifocal brain infarction. On additional cervical spinal MRI, it showed atypical MRI findings of SCI, considered late acute to early subacute phase, which were similar to those seen in the acute phase of multiple sclerosis (MS). Additional DWI revealed restricted diffusion. From these findings, it could be inferred that the patient's SCI occurred at the same time as the multifocal brain infarctions caused by atrial fibrillation.

Conclusion: A DWI sequence of spine MRI could be helpful in the diagnosis of acute to subacute phase SCI and in differentiating with acute MS.

Keywords: Spinal cord infarction; atrial fibrillation; diffusion-weighted imaging; magnetic resonance imaging; multiple sclerosis; subacute infarction.