Hypoxic Brain Injury Mimicking a Spinal Cord Disease: An Unusual Neurological Consequence of Cardiac Arrest

Cardiac arrest remains a major cause of both death and long-term disability, particularly neurological impairment. The well-known complication of cardiac arrest is hypoxic-ischemic encephalopathy (HIE), typically manifesting with altered consciousness and cognitive impairment. We report the rare case of a 51-year-old man who developed bilateral lower limb weakness and neurogenic bladder after an out-of-hospital cardiac arrest due to an inferior ST-segment elevation myocardial infarction (STEMI). Given the clinical presentation, a spinal cord lesion, such as a watershed ischemic spinal cord stroke, was suspected. However, extensive spinal imaging revealed no abnormalities. Instead, brain MRI findings were consistent with HIE, suggesting cerebral hypoxia as the underlying cause of the patient's lower limb dysfunction. This case highlights the importance of considering HIE as a differential diagnosis in post-cardiac arrest patients presenting with lower limb weakness, particularly when spinal imaging is unremarkable. Early recognition is essential for appropriate management and prognosis.