Hypotension-induced transverse spinal cord ischemia

Background: Spinal cord infarction is rare, with spontaneous, non-traumatic cases being extremely uncommon. Severe atherosclerosis may predispose to spinal ischemia during episodes of systemic hypotension, particularly in mid-thoracic watershed zones. Case report: We present a case of a 56-year-old woman with schizophrenia, a history of heavy smoking, and chronic use of nonsteroidal anti-inflammatory drugs. She presented with ischemic lower limbs and hypotension, following a self-inflicted neck wound. Computed tomography angiography revealed extensive chronic atherosclerotic disease of the distal aorta and iliac arteries with collateral circulation but no acute occlusion. After surgical control of bleeding and stabilization, she was found to have flaccid paraplegia and sensory loss below the TH10 level. Magnetic resonance imaging confirmed acute spinal cord infarction with well-demarcated ischemia, that was treated conservatively. Despite prompt hemodynamic stabilization, her neurological deficits did not resolve. Conclusion: This case highlights spontaneous spinal cord infarction as a rare but serious complication of transient hypotension in patients with severe atherosclerosis. Prompt recognition is essential, though therapeutic options remain limited.