Imaging Characteristics, Clinical Presentation, and Prognosis of Spinal Cord Infarction

Study design : Retrospective cohort study. Introduction : Spinal cord infarction is a rare condition, and many aspects of its pathophysiology remain unclear. The purpose of this study is to conduct a comprehensive analysis of the clinical symptoms, imaging changes, and prognosis of spinal cord infarction to elucidate its pathophysiology. Setting : The multiple institutions in Japan. Methods : We retrospectively analyzed the clinical course and imaging findings of 19 patients diagnosed with spinal cord infarction at affiliated institutions between 2012 and 2022, based on medical records. Prognosis was assessed using the modified Rankin Scale (mRS), with a favorable outcome defined as the ability to walk independently (mRS 0–3) at discharge. Results : The study cohort consisted of 15 male and 4 female patients, with a mean age of 62.7±18.4 years. Eleven patients were iatrogenic following cardiac surgery and epidural anesthesia. Among eight patients who underwent diffusion-weighted imaging (DWI) within two days of onset, five exhibited hyperintensity at the infarcted site. Clinically, 12 patients presented with anterior spinal artery syndrome, five with Brown-Séquard syndrome, and two with transverse infarction. A favorable prognosis at discharge was observed in six patients, five of whom had Brown-Séquard syndrome, showing a significant association between a good prognosis and Brown-Séquard syndrome (p < 0.01). Conclusions : DWI in MRI can aid in the early diagnosis of spinal cord infarction immediately after onset. Additionally, the findings suggest that patients with Brown-Séquard syndrome have a favorable prognosis for gait ability.