Young Woman With Sudden-onset Neck Pain and Quadriplegia: A Case Report

Abstract Introduction: Sudden-onset quadriplegia is a neurologic emergency that requires immediate management. Anterior spinal artery syndrome (ASAS) is rare, but can cause sudden-onset quadriplegia. Magnetic resonance imaging (MRI) is an essential imaging modality for diagnosing ASAS.Case presentation: A 31-year-old woman without previous medical history was transferred to our facility for further workup of sudden-onset neck pain with quadriplegia. Diffusion-weighted imaging (DWI) revealed hyperintense signals predominantly in grey matter with a decreased apparent diffusion coefficient (ADC). These findings strongly suggested ASAS with spinal cord infarction. Edaravone, heparin, and aspirin with steroid pulse therapy was immediately initiated. Twelve days in an intensive care unit was required for dyspnea. Symptoms gradually resolved with rehabilitation, but the patient was wheelchair-bound without bladder control and was transferred to a rehabilitation facility on hospital day 48. Conclusion: A combination of DWI with ADC mapping of the spine should proceed as soon as possible to ensure appropriate management. Early treatment with edaravone, aspirin and steroid pulse therapy may prove beneficial for ASAS.