Imaging recommendation · Neuro · Head & Neck

Acute para/quadraparesis without trauma, suspected spinal cord infarction

Q: What's the alternative imaging for acute para/quadraparesis without trauma, suspected spinal cord infarction when suspected dissection or aortic etiology?

CT — CTA Aorta + Spine MRI (iv contrast).

Recommended: MRI Spine (entire cord) with DWI is the preferred imaging study for acute para/quadraparesis without trauma, suspected spinal cord infarction. Anterior spinal artery syndrome from aortic surgery, atherosclerosis, or hypotension.

Recommended study

MRI Spine (entire cord) with DWI

MRI IV contrast Preferred Neuro · Head & Neck EmergencyAcute inpatient Reviewed 2026-05

Anterior spinal artery syndrome from aortic surgery, atherosclerosis, or hypotension. DWI restriction in central cord (pencil-like).

If the default doesn't apply

Suspected dissection or aortic etiology

CT CTA Aorta + Spine MRI IV contrast

Watch-outs

Mimics that need different management

Transverse myelitis (steroids), epidural hematoma (surgery), cord compression (surgery), AVF (embolization) — all on the differential.

Pearls

Anterior cord syndrome: motor + pain/temperature loss with preserved proprioception (dorsal columns spared).
Watershed zone (T4-T8) most vulnerable to global hypoperfusion.
Owl's eye sign on axial T2: bilateral anterior horn hyperintensity.