The owl’s eyes sign in spinal cord infarction: A rare presentation at the conus

Abstract

Spinal cord infarction is an uncommon cause of acute myelopathy, particularly when involving the anterior spinal artery (ASA) territory. Early diagnosis is challenging due to its rarity and the overlap of symptoms with other acute spinal disorders. We report the case of a 55-year-old woman with no previous medical history who developed <i>sudden, severe dorsal pain</i> during routine household activities, followed within hours by <i>abrupt-onset paraplegia</i>. Spinal MRI demonstrated <i>T2 hyperintensity and restricted diffusion affecting the anterior horns</i>, creating the characteristic <i>"owl's eye" sign</i>, consistent with acute ischemia of the ASA territory. No compressive lesion was identified. Further evaluation revealed <i>new-onset atrial fibrillation</i>, suggesting an embolic mechanism for the vascular occlusion. The clinical presentation and imaging findings were typical of anterior spinal cord infarction, which reflects the high metabolic vulnerability of the gray matter within the ASA distribution. Diffusion-weighted imaging played a key role in confirming the diagnosis and excluding alternative causes of acute myelopathy. This case emphasizes the importance of considering spinal cord infarction in patients presenting with sudden dorsal pain and rapid neurological decline. Early MRI evaluation and identification of underlying vascular risk factors such as atrial fibrillation are essential to guide timely management.