B49-14 Beyond the Chest: Spinal Cord Infarction Masquerading as Pericarditis

Abstract Introduction Spinal cord infarction (SCI) is an uncommon ischemic entity, accounting for 1% of all strokes. It most often presents with acute-onset weakness, sensory loss, and autonomic dysfunction. However, atypical cases may initially manifest with isolated pain, leading to diagnostic delay. Although chest pain is typically cardiac, pulmonary, or musculoskeletal in origin, it can rarely originate from the spinal cord, particularly when ischemia involves thoracic segments. Recognizing this overlap is critical to avoid misdiagnosis and prevent neurological deterioration. Case Presentation A 58-year-old woman with anemia, asthma, and obesity presented with acute, severe chest pain radiating to her back and left arm, exacerbated by inspiration and partially relieved by leaning forward. ECG revealed nonspecific T-wave changes, troponin levels were normal, and echocardiography showed preserved ejection fraction with a small pericardial effusion. Pericarditis was diagnosed, and she was discharged on NSAIDs and colchicine after a negative cardiac catheterization. The chest pain persisted over a course of one week and the patient returned with acute bilateral lower extremity weakness, paresthesia, abdominal numbness, and urinary retention. Neurological examination revealed decreased sensation below the umbilicus and flaccid paralysis of both legs. MRI demonstrated T2 hyperintensity and cord swelling at T1-T2 and T3-T4, consistent with ischemic myelopathy in the anterior spinal artery distribution. MRA and CTA were unremarkable, and CSF studies ruled out infectious or inflammatory etiologies. She was treated with high-dose intravenous methylprednisolone, followed by a prednisone taper and rehabilitation, resulting in partial neurological recovery. Discussion This case underscores the diagnostic challenge of spinal cord infarction presenting as isolated chest pain, a presentation that can mimic pericarditis, myocardial ischemia, or aortic pathology. Similar cases in the literature describe thoracic SCI initially mistaken for cardiac or pleuritic pain, with diagnosis often delayed until neurological symptoms emerge. Up to one-third of spinal cord infarctions present with chest pain alone, underscoring the importance of including spinal etiologies in the differential diagnosis of unexplained chest pain. MRI with diffusion-weighted sequences remains the gold standard for diagnosis, though early imaging may be normal. Prompt recognition and hemodynamic support(maintaining MAP 85-90 mmHg) are vital to optimise spinal cord perfusion. Clinicians should consider spinal cord pathology in patients with chest or back pain and neurological changes, even if cardiac workup is unrevealing. This case highlights the importance of maintaining a broad chest pain differential that extends beyond the thoracic cavity. This abstract is funded by: None