The acute spinal cord
infarction is a rare cause of acute-onset
paraplegia. Furthermore, it is specially uncommon that the
infarction occurs in patients with apparent low predisposition to
vascular disease. The 20210A allele of the
prothrombin gene (causing a threefold-increased risk in
venous thromboembolism) was recently associated with unexplained spinal cord
infarction in young women under treatment with
estrogens (
contraceptive pill). We report a case of
anterior spinal artery syndrome resulting from an ischaemic
infarction at the anterior aspect of the spinal cord in a healthy 50-year-old woman, carrying this mutation, being the first published case under treatment with transdermal
estradiol. She referred the typical sudden-onset
back pain associated to clinical
anterior spinal artery syndrome with sphincter dysfunction and nontraumatic
paraplegia. A possible
multiple sclerosis was ruled out and the
steroids or immunoglobulin therapy induced no clinical improvement. Cerebrospinal fluid and other investigations were all negative. Sequential MRI scans revealed development of spinal cord
infarction from T10 to T11, with increased signal in T2-weighted image (T2). Because she referred a previous
thrombophlebitis and suffered a
deep-vein thrombosis one month after
paraplegia, a complete coagulation study was performed.
Antithrombin, proteins C and S,
homocysteine,
factor V Leiden,
lupus anticoagulant and
anticardiolipin antibodies were all normal or negatives. In opposite, the 20210A variation was positive (heterozygous) and the
factor VIIIc level was very high (280 U/dl eight months later). We argue the relative importance of both findings. The patient had no a substantial recovery over a period of 20 months.Certainly, the
prothrombin 20210A seems to be associated with unexplained
ischemic myelopathy among the young women with
estrogens.