Infarction or
ischemia of the spinal cord is a rare entity and is often misdiagnosed as
inflammatory myelopathy in acute settings. Atherosclerotic disease can affect spinal arteries, leading to cord
ischemia with clinical presentation mixed with
myelopathy. We present a case of a 66-year-old male who came to the hospital with
unsteady gait and
numbness of all extremities without associated
pain for the past 48 hours. The neurological examination on admission directed the diagnosis towards
myelopathy of the cervical spine. However, the initial magnetic resonance imaging (MRI) of the cervical spine demonstrated
gliosis and restricted diffusion of the cord with multilevel neuroforaminal
stenosis but without central canal
stenosis or cord compression. The MRI brain, cerebrospinal fluid analysis, and rheumatologic evaluation were unremarkable. Four days into the
clinical course, the patient developed weakness and spasticity of all extremities prompting further evaluation. Computed tomography angiography (CTA) scan of the head and neck revealed right vertebral artery occlusion and intracranial atherosclerotic disease. He was started on
aspirin and
clopidogrel for secondary risk reduction. The hospital course was further complicated by
Ogilvie syndrome (OS), and the patient underwent uncomplicated
cecostomy.