Ferreira Sílvia, Fonseca Angelo, Correia Filipe, Cunha Joana, Taveira Mariana
Intensive Care Unit, Hospital Pedro Hispano, Matosinhos, PRT.
Neurology, Hospital Pedro Hispano, Matosinhos, PRT.
Cureus. 2024 Jul 8;16(7):e64083. doi: 10.7759/cureus.64083. eCollection 2024 Jul.
Spinal cord infarction (SCI) is a rare vascular event accounting for 1% of all strokes. Neurological syndromes may vary according to the arterial territory involved. This condition may differ in onset, severity, and recovery, making it a diagnostic challenge for clinicians. Diagnosis is made on a clinical basis, and neuroimaging (magnetic resonance imaging (MRI)) provides confirmatory evidence. A 72-year-old male, with a medical history of being overweight, hyperuricemia, dyslipidemia, and cigarette smoking presented to our emergency department (ED) with sudden-onset leg weakness. He reported chest pain with radiation to the back, followed by sudden arm and leg weakness, evolving to inferior limb plegia within four hours. He also noticed a loss of sensation below the breast region. On admission, vital signs were stable. Neurological examination demonstrated paraplegia of inferior limbs with absent deep tendon reflexes. Both pinprick, vibrational, and proprioceptive sensitivities were absent below T6. A diagnostic workup revealed lactescent serum suggesting severe hypertriglyceridemia. A clinical diagnosis of spinal cord infarction was made, which was later confirmed with MRI demonstrating an acute ischemic lesion in the anterior spinal artery (ASA) with the "owl's eye" sign, from T5 with extension to the cone. Neurological examination remained unaltered. He started aspirin and insulin perfusion. Since spinal cord injury is an uncommon cause of paraplegia, physicians should be extremely cautious. Despite the results of magnetic resonance imaging, the clinical picture was not consistent, which was finally explained by perilesional edema. To our knowledge, this is a rare case combining SCI with hypertriglyceridemia. Notwithstanding the lack of evidence linking reducing triglyceride levels to neurological recovery, insulin infusion was carried out given the hazards associated with sustaining such high levels of triglycerides. We aim to emphasize some characteristic MRI findings and the wealth of possible etiologies contributing to this clinical entity.
脊髓梗死（SCI）是一种罕见的血管性事件，占所有中风的1%。神经综合征可能因受累动脉区域而异。这种情况在发病、严重程度和恢复方面可能有所不同，给临床医生带来了诊断挑战。诊断基于临床，神经影像学（磁共振成像（MRI））提供确诊证据。一名72岁男性，有超重、高尿酸血症、血脂异常和吸烟病史，因突发腿部无力就诊于我们的急诊科（ED）。他报告胸痛并放射至背部，随后突然出现手臂和腿部无力，在4小时内发展为下肢瘫痪。他还注意到乳房区域以下感觉丧失。入院时，生命体征稳定。神经检查显示下肢瘫痪，深腱反射消失。T6以下针刺觉、振动觉和本体感觉均消失。诊断检查显示血清呈乳状，提示严重高甘油三酯血症。做出了脊髓梗死的临床诊断，后来MRI证实了这一诊断，显示脊髓前动脉（ASA）有急性缺血性病变，呈“猫头鹰眼”征，从T5延伸至圆锥。神经检查无变化。他开始服用阿司匹林并进行胰岛素灌注。由于脊髓损伤是截瘫的罕见原因，医生应格外谨慎。尽管磁共振成像结果如此，但临床表现并不一致，最终原因是病变周围水肿。据我们所知，这是一例罕见的脊髓梗死合并高甘油三酯血症的病例。尽管缺乏将降低甘油三酯水平与神经恢复联系起来的证据，但鉴于维持如此高甘油三酯水平的危害，仍进行了胰岛素输注。我们旨在强调一些特征性的MRI表现以及导致这一临床实体的多种可能病因。
