Elderly female with hyperlipidemia and HTN presenting with acute onset tingling back pain between her scapula with subsequent acute onset bl UE weakness and decreased sensation  with diminished reflexes throughout.

Differential for myelopathy

Our patient’s first MRI was normal but subsequent MRI demonstrated an acute spinal cord infarct in the territory of the anterior spinal artery. Anterior region of the spinal cord involves spinothalamic and corticospinal tracts therefore affecting both light touch/pain and motor function. Our patient likely suffered vascular myelopathy with incomplete ASA ischemia. Prognosis is poor for acute spontaneous spinal cord infarct, most need rehab. One main teaching point is to remember that presentations of spinal shock initially present with hyporeflexia or areflexia rather than hyperreflexia.