Spinal cord injury without radiographic evidence of trauma (SCIWORET) is a rare condition but remains relevant in elderly patients. Herein, we report the rare case of a 78-year-old woman who sustained a spinal cord injury after falling from a bicycle. Computed tomography (CT) at admission revealed an absence of bony abnormalities; however, motor and sensory deficits were observed below the C4 level, corresponding to Frankel grade B. Magnetic resonance imaging (MRI) demonstrated T2-weighted hyperintensity at levels C4–C7, indicative of spinal cord edema. Notably, axial MRI images revealed a loss of flow voids in the right vertebral artery, while contrast-enhanced CT identified a thrombotic occlusion accompanied by subsequent cerebellar infarction. Decompression surgery and coil embolization of the vertebral artery were accordingly performed. Despite early surgical intervention, no change in neurological status was observed, indicating complete spinal cord injury. The patient is consequently undergoing management in an intensive rehabilitation program focusing on optimizing respiratory function and preventing secondary complications. This case underscores the diagnostic value of flow void loss on axial MRI, which serves as a crucial indicator in the evaluation of patients with SCIWORET. • Spinal cord injury without radiographic evidence of trauma (SCIWORET) is rare. • We report a 78-year-old woman who sustained SCIWORET after a bicycle fall. • Initial CT revealed no evidence of spinal cord injury. • Subsequently, axial MRI showed a loss of flow voids in the right vertebral artery. • Contrast-enhanced CT showed a thrombotic occlusion with cerebellar infarction.
Hirose et al. (2026) studied this question.