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Anterior Spinal Artery Syndrome — RACP Adult Medicine MCQ

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ModerateNeurologyAnterior Spinal Artery SyndromeRACP Adult Medicine

A 55-year-old man presents with sudden onset flaccid paralysis of both legs with urinary retention. Examination shows absent lower limb reflexes, reduced anal tone, and a sensory level at T12. MRI spine shows a hyperintense signal in the anterior two-thirds of the spinal cord on T2-weighted imaging. Posterior columns are spared. What is the most likely vascular territory involved?

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Correct answer: D — Anterior spinal artery

Anterior spinal artery syndrome presents with sudden-onset paraplegia, loss of pain/temperature sensation (spinothalamic tracts), and autonomic dysfunction, with PRESERVED proprioception and vibration (dorsal columns – supplied by posterior spinal arteries). The anterior two-thirds of the cord is supplied by the anterior spinal artery. Causes include aortic surgery, aortic dissection, thromboembolism, and systemic hypotension.

Reference: eTG – 2025 – Neurology