Acute spinal cord infarction secondary to ankylosing spondylitis: a case report and literature review

Frontiers in Neurology, 2023 · DOI: 10.3389/fneur.2023.1221810 · Published: September 22, 2023

Cardiovascular Science Rheumatology Neurology

Simple Explanation

Spinal cord infarction (SCI) is a rare condition where the spinal cord doesn't get enough blood, leading to potential paralysis and incontinence. It's less common than strokes in the brain and can be difficult to diagnose and treat. Ankylosing spondylitis (AS) is a chronic inflammatory disease that can increase the risk of cardiovascular issues. This case report explores a possible link between AS and SCI, suggesting AS might contribute to SCI development. The patient in this report experienced sudden lower limb weakness, diagnosed as SCI. Despite challenges in performing a lumbar puncture due to spinal deformities from AS, doctors were able to rule out other conditions and provide treatment, leading to partial recovery.

Study Duration

Not specified

Participants

A 54-year-old man with ankylosing spondylitis, scoliosis, and hypotension

Evidence Level

Case Report

Key Findings

1
A 54-year-old man with a history of ankylosing spondylitis, scoliosis, and hypotension presented with acute spinal cord infarction.
2
The patient's spinal deformities due to AS made lumbar puncture challenging, requiring Taylor’s approach for successful CSF sampling.
3
Treatment with low-molecular-weight heparin, atorvastatin calcium, and methylprednisolone led to gradual recovery of sphincter function and partial restoration of strength.

Research Summary

This case report presents a rare instance of acute spinal cord infarction (SCI) in a patient with ankylosing spondylitis (AS). The patient presented with sudden lower limb weakness and was diagnosed with SCI after MRI and CSF analysis. The patient's AS-related spinal deformities complicated the diagnostic process, requiring an alternative lumbar puncture technique. Treatment included medications to reduce spinal cord edema and prevent thrombosis. The case highlights the importance of considering SCI in patients with AS presenting with sudden neurological deficits. It also suggests a potential link between AS and SCI, possibly due to inflammation and vascular complications associated with AS.

Practical Implications

Clinical Awareness

Physicians should consider spinal cord infarction in patients with ankylosing spondylitis who present with sudden loss of sensation and strength in their lower limbs.

Diagnostic Approach

Taylor’s approach can be a useful alternative for lumbar puncture in patients with spinal deformities due to ankylosing spondylitis.

Treatment Strategies

Prompt treatment with antithrombotic therapy and methylprednisolone may improve outcomes in patients with spinal cord infarction secondary to ankylosing spondylitis.

Study Limitations

1
The patient refused spinal angiography, limiting the ability to directly assess the patient’s vascular condition.
2
This is a single case report, which limits the generalizability of the findings.
3
The exact mechanism linking ankylosing spondylitis and spinal cord infarction remains unclear.

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