Spontaneous Spinal Cord Infarction Presenting as Anterior Spinal Artery Syndrome: A Case Report.

Spinal cord infarction is a rare cause of acute myelopathy and may be difficult to recognize when it occurs outside a traumatic or perioperative setting. We report a 68-year-old man with hypertension, type 2 diabetes mellitus, dyslipidemia, and active smoking who presented with sudden severe low back pain followed within one hour by rapidly progressive bilateral lower-limb weakness and sensory loss. Neurologic examination showed severe paraparesis, absent lower-limb reflexes, impaired pain sensation below T10, and relative preservation of proprioception. Aortic computed tomography angiography excluded dissection, and spinal magnetic resonance imaging demonstrated T2 hyperintensity with diffusion restriction in the anterior gray matter from T10-T11 to the conus medullaris, consistent with acute infarction in the anterior spinal artery territory. The patient received antiplatelet therapy, high-intensity statin therapy, venous thromboembolism prophylaxis, bladder management, and early rehabilitation. At follow-up, left lower-limb strength improved to 4/5, while right lower-limb plegia, neurogenic bladder, and wheelchair dependence persisted. This case emphasizes the importance of recognizing the characteristic clinical pattern of anterior spinal artery syndrome, urgently excluding aortic and compressive causes, obtaining diffusion-weighted spinal imaging, and initiating multidisciplinary supportive and rehabilitative care.