Acute spinal cord infarction as the initial presentation of acute lymphoblastic leukemia: first reported case

Abstract Background We report a rare case of a previously healthy female who presented with acute onset of back pain and lower limb weakness. She was ultimately diagnosed with spinal cord infarction (SCI) as the initial manifestation of acute lymphoblastic leukemia (ALL). Findings The diagnosis of SCI was based on the sudden clinical onset, neurological examination, and characteristic spinal cord changes on magnetic resonance imaging (MRI). Initial complete blood pictures were unremarkable. However, MRI also revealed additional abnormal signals outside the spinal cord. 18F-FDG-positron emission tomography-computed tomography (18F-FDG-PET/CT) suggested possible extramedullary hematopoiesis. Subsequent peripheral blood analysis showed abnormal circulating cells, and bone marrow examination confirmed the diagnosis of ALL. Conclusions This case highlights the diagnostic challenges of SCI as an initial and atypical presentation of acute leukemia, particularly in the absence of hematologic abnormalities at onset. Clinicians should remain alert to rare underlying causes of acute myelopathy, especially when imaging reveals extramedullary involvement.