Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.2074
Peer-review started: December 16, 2022
First decision: January 12, 2023
Revised: January 27, 2023
Accepted: March 3, 2023
Article in press: March 3, 2023
Published online: March 26, 2023
Processing time: 90 Days and 23.4 Hours
Infarction of the conus medullaris is a rare form of spinal cord infarction. The first symptom is usually acute non-characteristic lumbar pain, followed by lower limb pain, saddle numbness, fecal incontinence, and sexual dysfunction. Spontaneous conus infarction with "snake-eye appearance" on magnetic resonance imaging has rarely been reported.
We report a 79-year-old male patient with spontaneous conus infarction who had acute lower extremity pain and dysuria as the first symptoms. He did not have any recent history of aortic surgery and trauma. Magnetic resonance imaging revealed a rare "snake-eye appearance." In addition, we reviewed the literature on 23 similar cases and summarized the clinical features and magnetic resonance manifestations of common diseases related to the "snake-eye sign" to explore the etiology, imaging findings, and prognosis of spontaneous conus infarction.
We conclude that acute onset of conus medullaris syndrome combined with "snake-eye appearance" should be strongly suspected as conus medullaris infarction caused by anterior spinal artery ischemia. This special imaging manifestation is helpful in the early diagnosis and treatment of conus infarction.
Core Tip: Infarction of the conus medullaris is a rare form of spinal cord infarction, and there is no specific examination method in clinic. On the other hand, the "Snake-Eye Appearance" on the diffusion-weighted imaging sequence of magnetic resonance imaging highly suggests spinal cord infarction, although few cases of conus infarction have been reported. This special imaging manifestation is helpful in the early diagnosis and treatment of conus infarction.