Acute Spinal Cord Ischemia: Presenting with Back Pain

Abstract

Presentation
33-year-old female presented to the ED with an acute onset mid-thoracic back pain. Initial neurological examination revealed a power of 4/5 in her right leg. Re-assessment 10 hours later showed the power in the same leg had reduced to 1/5.

Diagnosis
MRI of the thoracic and lumbar spine revealed an acute spinal cord ischemia, involving the anterior segment of the spinal cord at the level of T2.

Treatment
She was administered analgesia whilst in the ED and subsequently transferred to a neurosurgical centre for a specialist review and further management where she was commenced on high dose IV steroids and thromboprophylaxis.

Discussion
This case emphasises that patients with seemingly benign back pain can have serious underlying aetiology. It highlights the importance of a detailed neurological examination and the need for urgent MRI in cases of unexplained back pain with neurological findings.