Spinal Cord Infarction as an Atypical Thromboembolic Complication of First-Diagnosed Atrial Fibrillation

Georgios Tyrikos,1,* Paschalis Karakasis,1,2,* Vasileios Nevras,1 Nikolaos Zelevaris,1 Chrysa Nalmpantidou,3 Georgia Gkounti1 1Cardiology Department, G. Gennimatas Hospital, Thessaloniki, Greece; 2Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital Hippokration, Thessaloniki, Greece; 3Radiology Department, G. Gennimatas Hospital, Thessaloniki, Greece*These authors contributed equally to this workCorrespondence: Paschalis Karakasis, Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital Hippokration, Thessaloniki, Greece, Email [email protected]: Atrial fibrillation (AF) is the most common sustained arrhythmia and a major contributor to systemic thromboembolism, typically manifesting as ischemic stroke or peripheral arterial occlusion. Although spinal cord infarction (SCI) represents a rare form of ischemic injury, accounting for only 1– 2% of all stroke events, its consequences are often devastating. The pathophysiological link between AF and SCI is poorly recognized, particularly in the setting of concurrent pulmonary embolism and hemodynamic instability.Case Summary: We report the case of a 91-year-old woman with chronic comorbidities who presented with first-diagnosed, asymptomatic AF and was found to have a submassive pulmonary embolism. Following initiation of anticoagulation, she developed acute flaccid paraplegia and hypotension. Spinal magnetic resonance imaging revealed a longitudinally extensive anterior-predominant T2 hyperintensity from T6 to the conus medullaris, consistent with acute anterior spinal artery territory infarction. Despite aggressive hemodynamic support, the patient’s condition deteriorated and she died shortly thereafter.Conclusion: SCI is a rare but catastrophic complication of AF. In patients with AF—especially those with concomitant venous thromboembolism or hypotension—new-onset paraplegia should prompt urgent spinal MRI to exclude ischemic myelopathy. Early recognition may guide supportive strategies, although prognosis remains poor in extensive thoracolumbar infarctions.Keywords: atrial fibrillation, spinal cord infarction, thromboembolism, cardiovascular imaging, magnetic resonance imaging, pulmonary embolism