As he was holding the exhibit, I noticed that he was moving it ever so gently and slowly, trying to get the air bubble to move to the representation of the
anterior spinal artery. But no matter how hard he tried, he couldn't do this.
The major differential diagnoses were spinal cord infarction secondary to acute
anterior spinal artery thrombosis or transverse myelitis.
A single anterior spinal artery arises from branches off both vertebral arteries to supply the anterior two-thirds of the spinal cord.
The typical patient at risk of anterior spinal artery syndrome is an elderly patient with a past history of arteriosclerosis or recent period of hypotension, who presents with a sudden onset of flaccid paralysis, abolished segmental reflexes and minor or patchy sensory disturbance.
Anterior spinal cord syndrome comprises ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral two-thirds of the spinal cord.
In this regard, we think that the vasculitis of the anterior spinal artery or its branches due to BD is the most likely abnormality that caused the thoracic cord lesion in our patient.