A 48-year-old woman was evaluated because of weakness and flexion spasms of both legs. During the daytime, she needed to catheterize herself every 2 hours.

Our patient had a spinal cord infarction (SCI). SCI is an uncommon but often devastating vascular disorder, accounting for approximately 1.2% of all strokes. A variety of causes are described (Tables 18.1 and 18.2). Initial investigations were geared to exclude the most common causes of a rapidly producing partial transverse spinal cord lesion, such as spinal cord compression, spinal cord trauma, acute parainfectious or demyelinating myelopathies, and central cord syndromes caused by tumors or hemorrhages. Arterial SCI can occur when the blood supply to the spinal cord is interrupted anywhere from the aorta to the intramedullary vasculature by a thrombotic or embolic vessel occlusion, inadequate systemic perfusion pressure, or a combination of both mechanisms.

Three basic vascular systems supply the spinal cord: (i) three spinal arteries (a single anterior spinal artery and paired posterior spinal arteries), (ii) radicular arteries, and (iii) terminal extramedullary and intramedullary arteries. The anterior spinal artery descends in the anterior sulcus of the spinal cord, supplying the anterior two-thirds of the spinal cord including the anterior horns, corticospinal tracts, and lateral spinothalamic tracts. The two posterior spinal arteries descend along the posterior surface of the spinal cord as an anastomotic network and supply the posterior one-third of the spinal cord including the dorsal columns. The anterior and posterior spinal arteries join in an anastomotic loop at the conus medullaris. Only a few radicular arteries supply the spinal cord. Among those, the arteria radicularis magna or artery of Adamkiewicz supplies the lower anterior thoracic and lumbosacral spinal cord. The artery of Adamkiewicz arises from the aorta and generally enters the spinal canal typically on the left side (T9-T12). The extramedullary and intramedullary systems are the terminal branches supplying the spinal cord; they are made up of the peripheral vasocorona that encircle the spinal cord and the central or sulcal arteries arising from the anterior spinal artery.