Cervical spinal cord infarct associated with patent foramen ovale

Abstract

Spinal cord infarct is a rare entity representing only one to two percent of all strokes 1,2 . There are only two previous reports of spinal cord infarct associated with patent foramen ovale (PFO), one in the anterior spinal artery (ASA) distribution and the other in the posterior spinal artery (PSA) 3,4 . Here, we report the case of a woman with spinal cord infarct in which the only possible etiology found was a PFO. CASE REPORTA 20-year-old woman with any previous known disease had a sudden interscapular pain and abdominal paresthesias. One day after that, she noted arms and legs weakness that persisted during the following weeks. Neurological examination revealed mild and symmetric legs, and arms paresis with exaggerated tendon reflexes and bilateral Babinski sign. There were no signs of lemniscal sensory deficits. There was a trunk and four limbs slight reduction of tactile and thermal sensory function. Magnetic resonance imaging (MRI) showed slight asymmetric T2-weighted hypersignals on the central H region of spinal cord extending from C5 to C7, compatible with spinal cord infarct (Fig 1). She was submitted to computed tomography angiography of the thoracic and cervical regions, which was normal. Holter was normal. The transesophageal ecocardiography revealed PFO with paradoxical interatrial shunt (Fig 2). All laboratorial data, including thrombophilias search, antinuclear antibodies, VDRL, sorologies for hepatitis, HIV, HTLV-1, anti-Ro and anti-La, were negative. The cerebrospinal fluid (CSF) analysis was normal. Routine laboratorial tests, including blood cell count, glucose, cholesterol and triglycerides, renal and hepatic function, were normal. Cranial MRI was normal.Based on these results, acetylsalicylic acid at a dose of 100 mg a day was introduced. Physical rehabilitation was initiated. The patient improved, and a minimal strength deficit and hyperreflexia persisted.

A Case of Paradoxical Embolism Causing Anterior Spinal Cord Syndrome and Acute Myocardial Infarction Following the Intradiscal Oxygen-Ozone Therapy

“…Sometimes a patient's intrathoracic pressure may increase dramatically due to pain during injection, facilitating a transient rise in atrial pressure and leading to a right-to-left shunt. Then gas embolus can reach the anterior spinal artery and coronary artery through the PFO (27). Assuming there is no right-to-left shunt, the venous gas embolus will lodge in the pulmonary vasculature and cause pulmonary artery hypertension.…”

Spinal Cord Infarction and Patent Foramen Ovale: Is There a Link

“…The presence of a patent foramen ovale (PFO) with atrial septum aneurysm (ASA) has been described as a risk factor for cryptogenic brain infarction. This is not clearly established for SCI, as there are only 3 reported cases of SCI associated with a PFO [5, 6, 7]. However, right-to-left shunting has also been related to spinal infectious diseases by septic embolism [8, 9, 10].…”