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

Sep 28, 2026

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Atrial fibrillation (AF) is a common sustained arrhythmia that strongly drives systemic thromboembolism, usually presenting as ischemic stroke or peripheral arterial occlusion. Spinal cord infarction (SCI) is rare, but the document highlights how AF may contribute through under-recognized cardioembolic mechanisms, particularly when pulmonary embolism and hemodynamic instability coexist. A reported case describes a 91-year-old woman with first-diagnosed, initially asymptomatic AF and submassive pulmonary embolism who rapidly developed acute flaccid paraplegia and hypotension after anticoagulation.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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Background

Case Summary

Conclusion

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International Medical Case Reports Journal Open Access Full Text Article C ASE REPORT 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 Gkounti 1 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 work Correspondence: Paschalis Karakasis, Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital Hippokration, Thessaloniki, Greece, [Email pakar15@hotmail.com](Email pakar15@hotmail.com) | Background: 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 | | --- | | Introduction
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions worldwide and posing a major public health challenge due to its association with thromboembolism, heart failure, and mortality.1 Of importance, up to 30% of AF cases are asymptomatic, yet silent AF confers a thromboembolic risk comparable to symptomatic presentations, underscoring the need for proactive detection, risk stratification and effective intervention.2,3 AF is a well-established risk factor for thromboembolism, most commonly presenting as ischemic stroke or systemic arterial embolism.4 In contrast, spinal cord infarction (SCI) represents a rare manifestation of embolic disease, accounting for only 1–2% of all ischemic events, yet it is associated with considerable morbidity and mortality.5–7 Diagnosis is challenging because symptom onset is abrupt while early neurological signs can be non-specific; timely access to definitive imaging therefore determines diagnostic certainty.8 Spinal cord infarction (SCI) is an uncommon cause of acute myelopathy, accounting for a small fraction of central nervous system ischemic events, yet it is associated with substantial long-term disability.9, 10 Recent cohort studies and systematic reviews have shown that the most frequent etiologies include aortic surgery and aortic pathology, followed by non-iatrogenic causes such as systemic hypotension, chronic vascular risk factors, and pr

FAQs

Why is spinal cord infarction considered a rare complication of atrial fibrillation?

SCI accounts for only about 1–2% of ischemic stroke events, yet it can be catastrophic. The document notes a poorly recognized pathophysiological link between AF and SCI.

What diagnostic imaging finding supported the diagnosis in the case?

Spinal magnetic resonance imaging showed a longitudinally extensive anterior-predominant T2 hyperintensity from T6 to the conus medullaris, consistent with acute anterior spinal artery territory infarction.

What clinical sign should prompt urgent spinal MRI in patients with atrial fibrillation?

New-onset paraplegia in patients with AF—especially with concomitant venous thromboembolism or hypotension—should prompt urgent spinal MRI to exclude ischemic myelopathy.

Sep 28, 2026

Uploaded by dhado