Publication:

Hyperacute anterior spinal artery infarction in a child with prothrombin G20210A mutation: a case report with brief review of literature

Anterior spinal artery territory infarction in children is rare, resulting from hypoperfusion or occlusion of the anterior spinal artery. The ischemia involves the anterior two-thirds of the spinal cord. It presents acutely with pain, para- or quadriplegia, dissociated sensory loss, bowel and bladder involvement, respiratory distress, and autonomic dysfunction. We present a case of a 14-year-old previously healthy girl, who presented with hyperacute quadriplegia and respiratory failure. Physical examination was compatible with a high cervical spinal cord lesion. Magnetic resonance imaging (MRI) of the spine with diffusion weighted imaging (DWI) revealed lesion of the ventral cervical cord between C2 and C6 levels, suggestive of infarct in the anterior spinal artery territory. Genetic studies revealed a prothrombin G20210A heterozygous mutation. She was treated with anticoagulants and supportive care. She showed good improvement and was ambulant 6 months later.