Introduction: Spinal cord infarction (SCI) is a relatively rare disease. Abnormality on magnetic resonance imaging (MRI) is an important diagnostic criterion. It may be normal on the first day. Then abnormal signal will appear a few days later. There were some reports with negative MRI findings at the beginning. However, those reports were neither found abnormalities on repeat MRI nor without repeat MRI. Case Presentation: We report a case of SCI presented as paralysis of lower limbs and chest pain with no abnormalities on MRI through the course of disease in a 74-year-old female. Anti-platelet aggregation drugs, stabilizing plaque treatments and rehabilitation exercise were performed. The patient recovered significantly. She could walk independently a month after the onset. Conclusions: Although MRI provides important evidence for diagnosis, clinical manifestations are the most important when diagnosing. For patients who were highly suspected of SCI clinically, treatment for vascular diseases should be applied as soon as possible even if no lesion is found on imaging examination.
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