Paraplegia due to Anterior Spinal Artery Stroke: Rehabilitative Program on Lower Extremity Weakness and Locomotor Function

Background: Spinal cord ischemia in the absence of trauma with a stroke in the territories of anterior spinal artery (ASA) attributed to paradoxical embolism through patent foramen ovale (PFO) is a rare event. Rehabilitative treatment is focused on the improvement of lower limbs muscle torque to consent a recovery of balance and gait. Methods: Case report of a 43-year-old woman with paraplegia after ASA stroke due to PFO Results: A 43-year-old woman was hospitalized for sudden and progressive increase of weakness of lower limbs few hours after evacuation effort by using the Valsalva maneuver. Neurological and physiatric examination revealed paraplegia, lower limbs dysesthesia, and hesitancy with delayed bowel emptying. Spine-MRI showed D12–L1 anterolateral cord ischemia. Transcranial doppler sonography examination disclosed a PFO with moderate right-left shunt. During hospitalization, the patient was treated with steroids and acetylsalicylic acid drugs. Then, she was transferred to the Department of Physical Medicine and Rehabilitation and submitted to intensive rehabilitation of balance and gait. First, the patient was treated to increase the lower limbs torque and trunk control using also functional electrical stimulation (FES) cycling. Then, she performed an aquatic treadmill increasing contemporaneously both the weight support on the paretic legs than gait velocity. Motor and urinary symptoms disappeared in 30 days. Conclusion: After diagnostic work-up, PFO was considered the only cause of disease, suggesting that this was a case of ASA due to probable paradoxical embolism. The patient was treated with pharmacological therapy and a rehabilitative protocol with good recovery of locomotor function and muscle strength.