Cervical spinal cord infarction in a patient with cervical spondylosis triggered by straining during bowel movement

Abstract An 82-year-old man experienced sudden-onset left shoulder pain and hemiparesis, which subsided on the third day. MRI revealed an ischaemic lesion at the C3–4 level together with disk herniation and cord compression from C3/4 to C6/7. On the fourth day, however, similar symptoms recurred when straining during defecation, and then progressed in a fluctuating manner and finally resulted in quadriparesis and respiratory impairment. A follow-up MRI showed fresh infarction of the anterior spinal artery (ASA) territory extending from C2 to C5. Straining during defecation may have induced the second exacerbation by elevating the venous pressure in the craniospinal axis and intervertebral disc pressure and causing minor damage and intraluminal thrombus in the ASA.