1204 - Spinal Artery Vasospasm in the Setting of Cocaine Use

Case Diagnosis: Spinal Artery Vasospasm Secondary to Cocaine Abuse Involving Anterior Spinal Artery and Posterior Spinal Artery and Involvement of Associated Watershed Areas

Case Description: 64 year old male PMHx hypertension, drug abuse, L4-L5 lumbar fusion in 2017 presented to ED for acute-onset paraplegia and urinary retention following crack cocaine use. MRI of thoracic and lumbar spine revealed abnormal increased signal within the spinal cord extending from approximately T9 through the conus without impingement upon the distal spinal cord or conus. Repeat MRI with contrast of thoracic and lumbar spine following high dose IV steroids revealed linear enhancement on the post-gadolinium images within the central portion of the conus consistent with infarct of the spine. The patient was admitted to inpatient rehabilitation as a T11 Asia A NTSCI, where he had no significant functional improvement and was discharged to SNF with a suprapubic catheter.

Discussions: Acute spinal cord ischemia is rare, affecting the ASA distribution more often than the PSA distribution. Herein we describe a case of acute spinal cord ischemia affecting both the ASA and PSA distribution secondary to cocaine-induced vasospasm diagnosed by neurology by radiographic evidence and exclusion of other causes. ASA occlusion is the leading cause of spinal cord infarctions which may occur secondary to vasospasm caused by stimulant medications. PSA involvement with spinal cord infarcts is exceedingly rare.

Conclusions: Our patient in his 60s with acute spinal cord ischemia involving both the ASA and PSA territories in the thoracic spine following cocaine use is a singular presentation that ultimately led to severe disability. Unfortunately this patient did not experience significant improvement. It is important for Clinicians to be aware of cocaine-induced vasospasm as a cause of acute paraplegia to ensure timely and proper intervention.