Complex movement disorder in an elderly patient and the chimera effect

Several diseases that can lead to an acute spinal cord lesion were investigated. Demyelinating diseases were excluded by normal cranial MRI and normal CSF examination. Infection myelitis was excluded by the normal CSF examination and negative serologies. Spinal cord compression and tumors were excluded by the spinal MRI. Also, the spinal MRI was consistent with infarct diagnosis. Several etiologies of spinal cord infarct were investigated. Aortic and vertebral dissections were excluded by computed tomography angiography. Vasculitis was excluded by normal CSF and negative autoantibodies. There was no risk factor for atherosclerosis. Cervical spine disease was excluded by cervical MRI. There were not triggering movements. The only risk factor found was the PFO. There are two reported cases of spinal cord infarct associated with PFO, one in ASA territory and other in PSA territory, both in the thoracic region. To our knowledge, this is the first case of cervical spinal cord infarct in the ASA territory associated with PFO already described. The best approach to prevent recurrences in patients with PFO is not yet established, but there are reports of treatment with acetylsalicylic acid, warfarin, and closure of PFO5. RA: right atrium; LA: left atrium; Ao: Aorta; PFO Shunt: patent foramen ovale shunt.