Idiopathic Spinal Cord Infarction: A Case Report of an Unusual Diagnostic Dilemma and Therapeutic Challenge.

We report a 23-year-old male patient with acute respiratory distress and progressive quadriparesis following a football match, without preceding trauma. Initial imaging and cerebrospinal fluid studies were unremarkable. Spinal MRI revealed an infarction in the anterior spinal artery territory (C2-D1). Extensive etiological workup was negative. Despite treatment with corticosteroids and intravenous immunoglobulin, neurological recovery was limited. The patient required tracheostomy and intensive rehabilitation, eventually regaining partial motor function. Idiopathic spinal cord infarction (SCI) is rare, particularly in young patients. Diagnosis is challenging due to overlap with other causes of acute myelopathy. No evidence-based treatments exist; management relies on supportive therapy and early rehabilitation. Clinicians should maintain a high index of suspicion for SCI even in young patients. Early diagnosis and multidisciplinary rehabilitation remain crucial for achieving optimal outcomes.