У 55-летней женщины за четыре часа развилась паралич из-за инсульта спинного мозга, выявленного по знаку «глаза совы» на МРТ

Her Back Pain Turned to Paralysis in Four Hours and Her MRI Showed Two Glowing Owl Eyes A 55-year-old woman with no medical history was doing housework when a sudden, intense pain wrapped around her mid-back like a belt. Within four hours she could not move her legs at all. By the time she reached the emergency department, her lower limbs were completely paralyzed while her cranial nerve function remained intact. She had lost pain and temperature sensation, the dissociated pattern that points toward the front of the spinal cord rather than the whole of it. The imaging that followed produced one of the more distinctive pictures in neuroradiology: two bright, symmetrical dots sitting side by side at the front of the cord, a pattern radiologists call the owl's eye sign. The case was published in Radiology Case Reports by a team from the Mohammed V Military Instruction Hospital in Rabat, Morocco, and appears in the journal's April issue. Two Bright Dots at the End of the Cord The owl's eye sign is not a metaphor stretched for effect. On an axial MRI slice, the two anterior horns of the spinal cord light up as round paired foci, and the resemblance is immediate. In this patient the bright signal sat at the terminal portion of the cord, near the conus, which is an unusual location for the finding. Spinal MRI showed T2 hyperintensity along with restricted diffusion in the anterior horns, consistent with acute ischemia in the territory supplied by the anterior spinal artery. No compressive lesion was found. Restricted diffusion is the technical detail that matters most. It is the same signature radiologists look for in an acute brain stroke, and it is what separates a dead or dying region of tissue from an inflamed one. The anatomy explains why the anterior horns light up first. They are made of gray matter, which is more metabolically demanding than the surrounding white matter, and the anterior spinal artery supplies roughly the front two thirds of the cord. When that supply fails, gray matter fails first. A Heart Rhythm Nobody Had Detected Finding the infarct answered only half the question. The team then had to explain why a previously healthy woman had lost blood flow to her spinal cord. Further evaluation revealed new-onset atrial fibrillation. No other embolic source and no vascular malformation turned up. The authors identify the arrhythmia as the likely origin, meaning a clot formed in the fibrillating heart and traveled into the spinal circulation. Atrial fibrillation is common and often silent. The National Heart, Lung, and Blood Institute notes that it often occurs with no symptoms at all, and some people notice nothing until a complication arrives. The American Heart Association describes the condition as carrying an estimated fivefold increased risk of stroke, because blood pooling in the upper chamber can clot and be pumped out. The overwhelming majority of those clots end up in the brain. This one did not, which is part of what makes the case worth reading. The report identifies atrial fibrillation as the probable mechanism rather than a proven one. Establishing embolic causation in an individual patient is difficult, and the authors are careful with the wording. The Diagnostic Trap That Costs Patients Time Spinal cord infarction is rare enough that many clinicians will never manage one. A German case report in Neurological Research and Practice put spinal cord ischemia at less than one percent of all strokes and six to eight percent of spinal cord diseases. Its rarity is compounded by a look-alike problem. Acute myelopathy from inflammation, particularly transverse myelitis, produces overlapping symptoms and can resemble ischemia on early imaging, but the two conditions are managed very differently. Compressive causes have to be excluded as well. Speed is part of the picture. The Rabat authors note that most patients with spinal cord infarction reach their maximal neurological deficit within 12 hours, and their patient hit that point in four. But the discriminator they lean on hardest is not the clock. It is diffusion-weighted imaging, which they describe as central to separating ischemic myelopathy from the inflammatory and compressive alternatives. Standard MRI sequences can look unremarkable early in the course, which is why the diffusion sequence carries so much weight. What This Case Does Not Establish One patient cannot show how often atrial fibrillation causes spinal cord strokes, and this report does not change screening recommendations for anyone. It does not describe long-term recovery, so no conclusion about prognosis follows from it either. The owl's eye sign is likewise not exclusive to embolic causes. Published cases have tied it to aortic arch repair in a newborn, to postpartum clotting problems, to vertebral artery occlusion and to profound blood loss. The sign localizes the injury. It does not name the culprit, and it is not required for the diagnosis. What the case does illustrate is a pattern worth recognizing: sudden severe back pain followed by rapid weakness is a neurological emergency, not a musculoskeletal one. The authors emphasize early MRI and a search for vascular risk factors. Anyone who develops abrupt severe back pain with new weakness, numbness or loss of bladder control should seek emergency care immediately rather than waiting to see whether it improves. Key Questions Answered What is the owl's eye sign? It is an MRI pattern in which the two anterior horns of the spinal cord appear as bright paired dots on a cross-sectional image, resembling eyes. It points toward ischemia in the anterior spinal artery territory. What happened to this patient? A 55-year-old woman with no medical history developed sudden severe mid-back pain during housework and progressed to complete leg paralysis within four hours. Why did her spinal cord lose blood flow? Testing revealed previously undiagnosed atrial fibrillation. The authors consider a clot from the fibrillating heart the likely source, though causation in an individual case is difficult to prove. How common is spinal cord stroke? Uncommon. Published estimates place spinal cord ischemia at under one percent of all strokes and six to eight percent of spinal cord diseases. Why is it misdiagnosed? Inflammatory conditions such as transverse myelitis can look similar on early imaging. The authors point to diffusion-weighted MRI as the most useful way to separate them. What symptoms should prompt emergency care? Sudden severe back pain followed by weakness, numbness or loss of bladder or bowel control requires immediate emergency evaluation. Published by Medicaldaily.com