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The Quest for the Cause of Spinal Cord Ischemic Lesions: Impaired Arterial Supply or Venous Drainage?

Incomplete transverse spinal cord lesion after ischemic insult of arterial origin is not uncommon, but ischemic spinal cord lesion caused by impairment of the venous drainage system is very rare. A 33-year-old man with the postinfective hypercoagulation syndrome and incomplete cervical spinal cord ischemic lesion with a typical clinical course as in Foix-Alajouanine's syndrome is described. Postischemic and postnecrotic gliosis of the spinal cord tissue in segments C6-Th2 was confirmed at MRI examination. The location of the postischemic medullar lesion did not have the typical “pencil-like” appearance usually present in the impairment of arterial supply. Instead, the lesion had an atypical distribution of ischemic changes in the ventral marginal part of the spinal cord near the sulcomarginal incisura suggesting impairment of the venous drainage system. After low-molecular heparins and antibiotic treatment, the patient made a very good recovery with functional restitution. Spinal MR-angiography showed a normal arterial blood supply.