Acute Paraplegia with Cognitive Alterations After Bilateral Infarcts in Cerebral Small Vessel Disease

Cerebral small vessel disease (SVD) affects the small arteries, arterioles, venules and capillaries in the brain and can be identified clinically and/or radiologically. We describe the case of a 71-year-old man with sporadic cerebral SVD who presented with acute paraplegia with urinary incontinence and recent cognitive impairment that developed after the occurrence of ischaemic lesions. LEARNING POINTS: Cerebral small vessel disease (SVD) is extremely common and can mimic severe injury of lower motor neurons. Newer imaging techniques have significantly helped in the diagnosis of SVD. A combination of bilateral motor and/or sensory deficits located only in the lower limbs should raise the possibility of the bilateral deep lesions that can be observed in cerebral SVD.