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The anterior spinal artery (ASA) has multiple anastomoses along its path and therefore spinal stroke due to ASA occlusion is a rare event. Following an ASA occlusion, collateral blood flow, although inadequate to meet the needs of the spinal cord, may be enough to prevent a sudden stroke and instead may result in a gradual loss of cord function. The etiologies are mostly embolic, inflammatory, and traumatic. Atherosclerosis and resultant stroke is very rare in the ASA. The acute ASA syndrome is characterized by bilateral flaccid paresis or plegia below the lesion level, loss of motor reflexes, and dissociated sensory loss. Treatments are focused on the prevention of secondary ischemic events and on management of complications related to spinal cord dysfunction.

Publisher Summary This chapter presents a medical case of acute paraparesis. A 48-year-old woman was admitted with a 4-day history of increasing weakness in both lower limbs, together with a feeling of tightness and band-like constriction of both ankles. At the time of onset of the symptoms, she had acute middorsal pain without radiation lasting for approximately 30 min. In the 24 h before admission, there had been disturbance of bladder function and she had been incontinent of urine. There was no significant previous history and, in particular, had no history of diplopia, visual disturbance, dizziness, or speech disturbance. There was also no previous history of abnormalities in function of any limb. She had suffered a mild, uncomplicated, upper respiratory tract infection 10 days before admission. On examination, there was no visible abnormality over the dorsal spine and no spinal tenderness. Cranial nerves and upper limbs were normal. The clinical signs suggest an acute lesion at D6. Anterior spinal artery occlusion would be associated with a dissociated sensory loss, that is, retained dorsal column modalities.