Cryptogenic Multifocal Infarctions Involving Brain and Spinal Cord in a Patient With Patent Foramen Ovale: A Case Report.

We report the case of a 46-year-old female with a history of gestational diabetes mellitus (GDM) who presented with acute onset flaccid quadriplegia, respiratory distress, and multifocal cerebral infarctions. Initial clinical suspicion favored inflammatory myelopathy; however, advanced neuroimaging demonstrated a long-segment anterior spinal cord infarction extending from the cervical to upper thoracic region, along with bilateral cerebellar and occipitoparietal infarcts. A patent foramen ovale and hypoplastic vertebral artery suggested a possible embolic and hemodynamic mechanism. This case illustrates the diagnostic complexity in distinguishing vascular infarction from inflammatory myelopathies and underscores the importance of thorough imaging and vascular workup in acute flaccid paralysis.