Seventy-three-year-old male admitted due to a sudden episode of cervical pain after cervical flexion-extension while farming. The physical examination conducted showed clinical manifestations that were consistent with the syndrome of acute central cervical spinal cord injury and acute respiratory failure. The cervical magnetic resonance imaging conducted confirmed the diagnosis of anterior spinal cord ischemia showing the classical snake eye-image. The sagittal view showed pencil-like signal hyperintensity (Fig. 1). This signal hyperintensity spread from C2–C3 towards C5–C6, with damage to the central and anterior spinal cord and degenerative changes at these levels. The physical examination was completed with a pulmonary ultrasound that revealed the presence of one 0.8mm-right hemi-diaphragmatic excursion suggestive of right diaphragmatic paralysis (Fig. 2) following damage to the phrenic nerve (C3–C5). The spinal cord nerve is a rare entity that can be challenging when it comes to achieving diagnosis. One possible etiology is cervical arthrosis such as in this case due to compression of the spinal arteries by the osteophytes following prolonged postural changes.

Figure 1.

T2-weighted MRI images. The axial slice reveals one snake eye-lesion suggestive of spinal cord infarction. The sagittal slice shows pencil-like signal hyperintensity.

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Figure 2.

Lung ultrasound of right hemithorax (mode M). It reveals the presence of one 0.8mm-diaphragmatic excursion suggestive of right diaphragmatic paralysis.

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