Disclosures: Kristen D. De Vries, DO, MS: No financial relationships or conflicts of interest

Case Description: The patient presented with bilateral lower extremity weakness, upper motor neuron signs, and a T3-4 sensory level. Initial MRI spine with and without contrast was unremarkable. Patient received 1 dose of intravenous immune globulin for concern for atypical early acute inflammatory demyelinating polyneuropathy (AIDP). Upon re-evaluation, treatment was changed to steroids for concern for acute transverse myelitis. He later developed a headache prompting an MRI brain which demonstrated dural venous sinus thrombosis. A repeat MRI spine demonstrated enhancing hyperintensity on the dorsal aspect of the spine from C5-T2. Patient received pulse steroids with oral taper and started on full dose anticoagulation with Lovenox. He was discharged to acute inpatient for intensive physical and occupational therapy.

Setting: Tertiary care hospital.

Patient: An 18-year-old male presenting with acute spinal cord venous infarct. Assessment/

Results: Three months post discharge, patient was reported to have significant improvement in overall functional status. Patient’s hypercoagulable work was not conclusive, but it believed to have a hypercoagulable disorder of unknown type due to strong family history.

Discussion: Posterior spinal cord infarction is rare and most commonly presents with unilateral symptoms. Initial imaging is often negative and, therefore, can initially appear to be other conditions, such as transverse myelitis or AIDP. Repeat MRI is required to accurately diagnose this condition.

Conclusion: Exact diagnosis is extremely important in any spinal cord condition, and especially when initial work up appears negative, in order to formulate an effective treatment plan.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spinal-cord-venous-infarct-presenting-as-acute-transverse-myelitis-a-case-report/