Letter to the Editor

Extensive Spinal Cord Infarction: A Rare Challenging Entity

Vitorino Modesto dos Santos1, and Taciana Arruda Modesto Sugai2
1Armed Forces Hospital, and Catholic University of Brasília-DF, Brazil
2Specialist, American Society of Neurophysiology, and Dermatologist of Brasília-DF, Brazil

Corresponding author: Vitorino Modesto dos Santos, vitorinomodesto@gmail.com

DOI: 10.31662/jmaj.2023-0168

Received: October 17, 2023
Accepted: October 24, 2023
Advance Publication: December 11, 2023
Published: January 15, 2024

Cite this article as:
dos Santos VM, Sugai TAM. Extensive Spinal Cord Infarction: A Rare Challenging Entity. JMA J. 2024;7(1):144-145.

Key words: extensive myelopathy, longitudinal lesion, spinal cord infarction

Dear Editor,

We read an illustrative case study of a spinal cord infarction (SCI) with a length of 13 vertebral bodies in a 78-year-old female, published in this journal by Yashita D, et al. (1) Because the mean measure of SCIs is approximately three vertebral bodies, the authors hypothesized that the development of an arteriosclerotic occlusion at the great posterior radiculomedullary artery may have caused the development of an exceeding long infarction (1).

Our aim is to comment on recent literature about challenging extensive SCIs (2), (3), (4), (5). Chiew YR, et al. reported the case study of a 58-year-old male, who had the diagnosis of an extensive SCI established by the contrast-enhanced thoracic spine MRI diffusion-weighted imaging and apparent diffusion coefficient (DWI and ADC) evaluations (2). The authors emphasized the differences between longitudinally extensive lesions of SCI and neuromyelitis optica (NMO); the lack of contrast enhancement in SCI is due to disrupted blood flow, and in NMO it occurs by inflammation and the intact blood flow (2). Costamagna G, et al. described a 57-year-old female with longitudinally extensive transverse myelopathy by SCI, but a negative MRI DWI and ADC at 9 h after onset (3). As the manifestations persisted, the exam repeated 72h later revealed a hyperintense “pencil-like” signal mainly from T1-T6 on T2 sequence, and with restricted diffusion (3). The authors stressed the clinical indicative data of potential SCI overriding the initially negative MRI findings and should not cause delay timely and appropriate management (3). Naik A, et al. reviewed data of SCIs among 147 patients, 55.4% men, and mean age of 45 years; 47.3% of cases were idiopathic, and 19.6% were due to vascular pathology (4). The authors concluded that the initial MRI images may be normal, the SCIs between T4 and T7 and those due to trauma or systemic/chronic causes have worst outcomes, and the cerebrospinal fluid drainage and antiplatelet aggregate therapy are more effective tools (4). Stenimahitis V, et al. evaluated data of 57 patients aged 18 years or older and presenting SCIs between 2006 and 2019; 30 had spontaneous SCIs, and 27 periprocedural SCIs (5). They highlighted that MRI DWI is the main tool for diagnosis; spontaneous SCIs often affect a unique segment and the periprocedural are more extensive, with more impairment and longer hospital stay; and the main goal of management is preventing complications (5).

Concluding, the authors believe that the comments here emphasize the cornerstone practical points well described by the authors of the initial reference.

Article Information

Conflicts of Interest


Author Contributions

VMS wrote the first manuscript, and TAMS edited and approved the final manuscript.

Approval by Institutional Review Board (IRB)

IRB approval was not required for this manuscript.

Informed Consent

Informed consent was not required for this study.


  1. 1.

    Yashita D, Hao A, Uchio N, et al. Extremely long spinal cord infarction. JMA J. 2023;6(3):350-1.

  2. 2.

    Chiew YR, Tan JMM. Longitudinally extensive transverse myelopathy in spinal cord infarction. Clin Case Rep. 2022;10(12):e6671.

  3. 3.

    Costamagna G, Meneri M, Abati E, et al. Hyperacute extensive spinal cord infarction and negative spine magnetic resonance imaging: a case report and review of the literature. Medicine (Baltimore). 2020;99(43):e22900.

  4. 4.

    Naik A, Houser SL, Moawad CM, et al. Noniatrogenic spinal cord ischemia: A patient level meta-analysis of 125 case reports and series. Surg Neurol Int. 2022;13:228.

  5. 5.

    Stenimahitis V, Fletcher-Sandersjöö A, El-Hajj VG, et al. Long-term outcomes after periprocedural and spontaneous spinal cord infarctions: a population-based cohort study. Neurology. 2023;101(2):e114-24.