To explore the clinical features, MRI features, cause, and prognosis of anterior spinal artery syndrome (ASAS) and improve the understanding of spinal cord infarction. Methods: The clinical features, MRI characteristics, treatment, and prognosis of 1 case of ASAS were retrospectively analyzed, and the relevant literature was reviewed. Results: The patient displayed acute onset of illness, back pain, paraplegia, thermal and pain sensory disorder, normal deep sense and tactile sense, urine retention, and fecal elimination disorder. MRI with DWI sequence showed hyperintensities at the T7-8 and T11-12 levels within the anterior portion of the spinal cord transection and slightly elevated T2 signals. Comprehensive treatment was adopted, and the patient had a good prognosis. We collected the data of 207 cases of ASAS. Most patients presented with acute or subacute onset, nerve root pain, paraplegia, dissociative sensory disorder, and autonomic nerve function disorder. Thoracic spinal cord infarction is most common. In early disease stages, DWI is able to detect regions of spinal cord infarction. Of the 207 patients, 74 (35.8% ) had unknown etiology. In patients under 18 years old, neck trauma was the primary cause of spinal cord infarction. In patients aged 18 to 45 years, aortic disease was the primary cause of spinal cord infarction. In patients over 45 years old, atherosclerosis was the primary cause of spinal cord infarction. Conclusion: ASAS is rare, and its clinical manifestations and etiologies vary greatly. The diffuse sequence of MRI is helpful for early diagnosis. Early diagnosis and comprehensive treatment is the key to improving prognosis