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Abstract
Compared to cerebral ischaemia, the frequency of spinal cord ischaemia is rare. Spinal infarcts lead to various types of neurological deficits, usually consisting of an abrupt and complete tetra- or paraplegia. Magnetic resonance imaging is the most valuable tool to show the infarct and to rule out other causes of acute spinal cord syndromes., such as myelitis or acute compressions. Nowadays, in western countries, most spinal cord infarcts are due to aortic diseases (atherosclerosis, aneurysm, dissection) or are of iatrogenic origin (mainly aortic surgery and interventional radiology), while other causes are rare. There is no specific treatment, besides prevention of complications, treatment of the underlying cause and rehabilitation.
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Affiliation(s)
- D Leys
- Inserm U 1172, CHU de Lille, University of Lille, Lille, France; Stroke unit, Department of Neurology, CHU de Lille, Lille, France.
| | - J-P Pruvo
- Inserm U 1172, CHU de Lille, University of Lille, Lille, France; Department of Neuroradiology, CHU de Lille, Lille, France
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Abstract
Context/Objectives: To describe demographics, clinical characteristics, and functional outcomes of patients with incomplete spinal cord injuries and posterior cord syndrome (PCS).Design: Five-year retrospective case series.Setting: Spinal cord injury (SCI) rehabilitation unit at a Level 1 tertiary university medical center.Participants: 9 patients with incomplete cord injuries diagnosed with PCS admitted to rehabilitation within the past 5 years.Outcome measures: Functional Independence Measure (FIM) motor scores, length of stay (LOS), discharge disposition.Results: Incidence of PCS was 2% with an average age of 62.0 years. The most common etiology for PCS was spinal cord compression from localized tumors (78%). Seven (78%) patients had paraparesis. All patients had an American Spinal Injury Association impairment scale (AIS) classification of AIS D. SCI-related complications most commonly included: neuropathic pain (78%), spasticity (44%), and neurogenic bladder (78%). Average LOS on the rehabilitation unit was 28 days. Average admission and discharge FIM motor scores were significantly improved (P = 0.001) from 41 to 65, respectively. Two-thirds (67%) of patients were able to walk at least 150 feet with a rolling walker prior to discharge. Most (78%) patients were discharged to home. Continence improved from admission to discharge from 22% vs 56% (bladder) and 67% vs 78% (bowel).Conclusions: We can conclude that PCS most often results in paraparesis due to tumor compression. Typical SCI-related medical complications are encountered. These patients often experience significant functional improvements during SCI rehabilitation with the majority also having bladder and bowel continence allowing them to return home at discharge.
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Affiliation(s)
- William McKinley
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health Systems, Richmond, Virginia, USA
| | - Adam Hills
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health Systems, Richmond, Virginia, USA
| | - Adam Sima
- Department of Biostatistics, Virginia Commonwealth University Health Systems, Richmond, Virginia, USA
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Barber K, Sarmiento C, Niehaus W. Hyperextension-Induced Dorsal Cord Syndrome: Case Presentation. PM R 2019; 12:518-521. [PMID: 31498971 DOI: 10.1002/pmrj.12249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/29/2019] [Indexed: 02/05/2023]
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Rojas S, Ortega M, RodríGuez‐Baeza A. Variable anatomic configuration of the posterior spinal arteries in humans. Clin Anat 2018; 31:1137-1143. [DOI: 10.1002/ca.23213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/03/2018] [Accepted: 05/09/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Santiago Rojas
- Unit of Human Anatomy and Embryology. Department of Morphological Sciences. Faculty of MedicineUniversitat Autònoma de BarcelonaCerdanyola del VallèsSpain
| | - Marisa Ortega
- Unit of Human Anatomy and Embryology. Department of Morphological Sciences. Faculty of MedicineUniversitat Autònoma de BarcelonaCerdanyola del VallèsSpain
- Institute of Legal Medicine and Forensic Sciences of Catalonia, Hospitalet de Llobregat Spain
| | - Alfonso RodríGuez‐Baeza
- Unit of Human Anatomy and Embryology. Department of Morphological Sciences. Faculty of MedicineUniversitat Autònoma de BarcelonaCerdanyola del VallèsSpain
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Magnetic Resonance Imaging and Clinical Features in Acute and Subacute Myelopathies. Clin Neuroradiol 2017; 27:417-433. [PMID: 28667382 DOI: 10.1007/s00062-017-0604-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
Differential diagnosis of acute and subacute transverse myelopathy includes inflammatory, infectious, vascular, metabolic and paraneoplastic etiologies. Information on the diagnostic approach to transverse myelopathy with regard to daily clinical practice is provided. The differentiation between five lesion patterns on magnetic resonance imaging (MRI) in myelitis may be helpful: (1) longitudinal extensive transverse myelitis, (2) short segment ovoid or peripherally located, (3) "polio-like", (4) granulomatous and (5) segmental with rash. A correlation with these imaging features is supported if the clinical course and neurological symptoms are known. Although the mean interval from onset to nadir of symptoms in spinal cord infarction is 1 h, an overlap with a fulminant course of myelitis is possible, and impaired diffusion may also occur in acute inflammatory processes. As a result, laboratory testing, including aquaporin-4 antibodies and cerebrospinal fluid analysis, is crucial for the correct interpretation of imaging findings. Moreover, the discrimination of acute complete and acute partial transverse myelitis is advantageous in order to identify diverse entities, the latter often being a precursor to multiple sclerosis. Additional brain imaging is mandatory in suspected demyelinating, infectious, neoplastic and systemic autoimmune disease. A symmetrical lesion pattern restricted to individual tracts or dorsal columns indicates subacute combined degeneration of the spinal cord and, in addition to deficiency syndromes, a paraneoplastic etiology should be considered.
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Sakurai T, Wakida K, Nishida H. Cervical Posterior Spinal Artery Syndrome: A Case Report and Literature Review. J Stroke Cerebrovasc Dis 2016; 25:1552-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/12/2016] [Accepted: 02/11/2016] [Indexed: 11/25/2022] Open
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Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology 2014; 57:241-57. [PMID: 25398656 DOI: 10.1007/s00234-014-1464-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purpose of this study was to analyse MR imaging features and lesion patterns as defined by compromised vascular territories, correlating them to different clinical syndromes and aetiological aspects. METHODS In a 19.8-year period, clinical records and magnetic resonance imaging (MRI) features of 55 consecutive patients suffering from spinal cord ischemia were evaluated. RESULTS Aetiologies of infarcts were arteriosclerosis of the aorta and vertebral arteries (23.6%), aortic surgery or interventional aneurysm repair (11%) and aortic and vertebral artery dissection (11%), and in 23.6%, aetiology remained unclear. Infarcts occurred in 38.2% at the cervical and thoracic level, respectively, and 49% of patients suffered from centromedullar syndrome caused by anterior spinal artery ischemia. MRI disclosed hyperintense pencil-like lesion pattern on T2WI in 98.2%, cord swelling in 40%, enhancement on post-contrast T1WI in 42.9% and always hyperintense signal on diffusion-weighted imaging (DWI) when acquired. CONCLUSION The most common clinical feature in spinal cord ischemia is a centromedullar syndrome, and in contrast to anterior spinal artery ischemia, infarcts in the posterior spinal artery territory are rare. The exclusively cervical location of the spinal sulcal artery syndrome seems to be a likely consequence of anterior spinal artery duplication which is observed preferentially here.
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Affiliation(s)
- Stefan Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital of the Goethe - University, Frankfurt / Main, Seckbacher Landstraße 65, D 60389, Frankfurt / Main, Germany,
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Tokumoto K, Ueda N. [Cervical cord infarction associated with unilateral vertebral artery dissection due to golf swing]. Rinsho Shinkeigaku 2014; 54:151-7. [PMID: 24583591 DOI: 10.5692/clinicalneurol.54.151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A-68-year-old man experienced nuchal pain and bilateral shoulder weakness that occurred suddenly after he performed a golf swing. He was conscious. His cranial nerves were normal, but bilateral deltoid and biceps muscle strengths weakened. Magnetic resonance image (MRI) showed no brain stem infarctions or cervical epidural hematoma. We tentatively diagnosed him with concussion of the spinal cord because of mild recovery of his bilateral upper limb weakness after several hours; he was later discharged. The next day, he suddenly developed serious tetraplegia and was admitted to the emergency department. His breathing was controlled by a respirator as he had expectoration difficulty and respiratory muscle paralysis. A lesion in the cervical cord became apparent on MRI; the right vertebral artery was not detected on magnetic resonance angiography. Cervical MRI showed the intimal flap and a lack of flow void in the right vertebral artery. These findings revealed a right vertebral artery dissection. Cervical cord infarction due to unilateral vertebral artery dissection is rarer than posterior cerebral infarction due to the same pathogenesis; however, some such cases have been reported. We consider the present case to be caused by cervical cord infarction associated with unilateral vertebral artery dissection resulting from golf swing.
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Richard S, Abdallah C, Chanson A, Foscolo S, Baillot PA, Ducrocq X. Unilateral posterior cervical spinal cord infarction due to spontaneous vertebral artery dissection. J Spinal Cord Med 2014; 37:233-6. [PMID: 24090478 PMCID: PMC4066433 DOI: 10.1179/2045772313y.0000000125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Ischemia of the cervical spinal cord is a rare complication of spontaneous vertebral artery dissection (VAD) and usually involves the ventral portion. We describe a less evocative clinical presentation and images of unilateral posterior spinal cord infarction due to spontaneous VAD in order to facilitate early diagnosis. FINDINGS A previously fit 30-year-old man presented with persistent headaches and proximal motor deficit of the right arm. He was diagnosed with spontaneous dissection of both vertebral arteries, with occlusion of the right one, and the right carotid artery. Neurological examination also revealed a right C2-C3 tactile sensory loss, with unilateral proprioceptive deficit below. Brain images revealed small bilateral cerebellar infarcts which could not be responsible for the clinical symptoms. Magnetic resonance imaging of the spinal cord showed a right posterior cervical spinal cord infarction. The patient achieved nearly complete recovery after several weeks of anticoagulation and rehabilitation. CONCLUSION AND CLINICAL RELEVANCE Infarction of the caudal portion of the cervical spinal cord, especially unilateral, caused by spontaneous VAD, has rarely been described and is certainly under-diagnosed due to less suggestive symptoms, like unilateral and mainly sensory deficit. Nevertheless, early diagnosis of this condition is important to guide patient management and rehabilitation.
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Affiliation(s)
- Sébastien Richard
- CHU Nancy, Service de Neurologie, Hôpital Central, Nancy Cedex, France,Correspondence to: Sébastien Richard, CHU Nancy, Service de Neurologie, Hôpital Central, 29 avenue du Marechal de Lattre de Tassigny-CO n° 34, 54035 Nancy Cedex, France.
| | - Chifaou Abdallah
- CHU Nancy, Service de Neurologie, Hôpital Central, Nancy Cedex, France
| | - Anne Chanson
- CHU Nancy, Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Central, Nancy Cedex, France
| | - Sylvain Foscolo
- CHU Nancy, Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Central, Nancy Cedex, France
| | | | - Xavier Ducrocq
- CHU Nancy, Service de Neurologie, Hôpital Central, Nancy Cedex, France
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Hsu CY, Cheng CY, Lee JD, Lee M, Huang YC, Wu CY, Hsu HL, Lin YH, Huang YC, Weng HH, Huang KL. Clinical features and outcomes of spinal cord infarction following vertebral artery dissection: a systematic review of the literature. Neurol Res 2013; 35:676-83. [DOI: 10.1179/1743132813y.0000000183] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Chia-Yu Hsu
- Department of NeurologyChang Gung Memorial Hospital, Yunlin, Taiwan
- College of MedicineChang Gung University, Taoyuan, Taiwan
| | - Chun-Yu Cheng
- College of MedicineChang Gung University, Taoyuan, Taiwan
- Department of NeurosurgeryChang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jiann-Der Lee
- College of MedicineChang Gung University, Taoyuan, Taiwan
- Department of NeurologyChang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng Lee
- College of MedicineChang Gung University, Taoyuan, Taiwan
- Department of NeurologyChang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ying-Chih Huang
- College of MedicineChang Gung University, Taoyuan, Taiwan
- Department of NeurologyChang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Ying Wu
- College of MedicineChang Gung University, Taoyuan, Taiwan
- Department of NeurologyChang Gung Memorial Hospital, Chiayi, Taiwan
| | - Huan-Lin Hsu
- College of MedicineChang Gung University, Taoyuan, Taiwan
- Department of NeurologyChang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ya-Hui Lin
- College of MedicineChang Gung University, Taoyuan, Taiwan
- Department of NeurologyChang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yen-Chu Huang
- College of MedicineChang Gung University, Taoyuan, Taiwan
- Department of NeurologyChang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hsu-Huei Weng
- College of MedicineChang Gung University, Taoyuan, Taiwan
- Department of Diagnostic RadiologyChang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Respiratory Care and NursingChang Gung University of Science and Technology, Chiayi, Taiwan
- Department of PsychologyNational Chung Cheng University, Chiayi, Taiwan
| | - Kuo-Lun Huang
- College of MedicineChang Gung University, Taoyuan, Taiwan
- Department of Neurology and Stroke CenterChang Gung Memorial Hospital, Taoyuan, Taiwan
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Infarti midollari. Neurologia 2013. [DOI: 10.1016/s1634-7072(13)65021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Murata K, Ikeda K, Muto M, Hirayama T, Kano O, Iwasaki Y. A case of posterior spinal artery syndrome in the cervical cord: a review of the clinicoradiological literature. Intern Med 2012; 51:803-7. [PMID: 22466844 DOI: 10.2169/internalmedicine.51.6922] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a patient with posterior spinal artery (PSA) syndrome due to vertebral artery (VA) dissection. A 63-year-old woman developed neck pain, bilateral shoulder and arm numbness, and paraparesis after prolonged neck extension during a dental procedure. Neurological examination revealed sensory deficits in the legs, paraparesis, cerebellar ataxia, urinary retention and constipation. Magnetic resonance imaging disclosed T2-hyperintense lesions in the posterolateral C4-C7 cord with partial enhancement. T1-hyperintensity and stenosis were found in the right VA at C3-C5. These clinicoradiological findings suggested bilateral PSA syndrome and unilateral VA dissection. This is the fourth report of VA dissection-induced PSA syndrome.
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Affiliation(s)
- Kiyoko Murata
- Department of Neurology, Toho University Omori Medical Center, Japan
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Struhal W, Seifert-Held T, Lahrmann H, Fazekas F, Grisold W. Clinical core symptoms of posterior spinal artery ischemia. Eur Neurol 2011; 65:183-6. [PMID: 21389729 DOI: 10.1159/000324722] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 01/30/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ischemia in the distribution of the posterior spinal artery is rare. METHODS Between 2004 and 2008 we observed 4 patients with posterior spinal artery ischemia (PSAI). RESULTS All patients had the expected loss of posterior column function but also suffered from motor deficits which were severe, and the leading symptom in 2 patients. Severe pain, bowel and bladder dysfunction were other concomitant symptoms. In 3 of 4 patients, a follow-up spinal MRI was needed to show the cord infarct together with vertebral body ischemia in 2 patients. CONCLUSION An acute onset of posterior column dysfunction with a variable degree of motor deficit and dorsalgia suggests PSAI.
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Affiliation(s)
- Walter Struhal
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.
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Sulcal Artery Syndrome after Vertebral Artery Dissection. J Stroke Cerebrovasc Dis 2010; 19:333-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 05/29/2009] [Indexed: 11/18/2022] Open
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Spinal Cord Infarction in Congenital Afibrinogenemia: A Case Report and Review of the Literature. J Stroke Cerebrovasc Dis 2009; 18:298-303. [DOI: 10.1016/j.jstrokecerebrovasdis.2008.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 11/02/2008] [Accepted: 11/03/2008] [Indexed: 11/18/2022] Open
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Seçkin H, Ateş O, Bauer AM, Başkaya MK. Microsurgical anatomy of the posterior spinal artery via a far-lateral transcondylar approach. J Neurosurg Spine 2009; 10:228-33. [PMID: 19320582 DOI: 10.3171/2008.12.spine08289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The posterior spinal artery (PSA) is a clinically significant vessel that may frequently be encountered during the far-lateral transcondylar approach. There have been a limited number of reports on the specific origin of the PSA in the literature. The aim of this study was to demonstrate the origin of the PSA. METHODS Thirteen cadaveric heads (26 sides) were injected with colored silicon. A bilateral far-lateral transcondylar approach was performed on each side. In every specimen the site of the origin of the PSAs, as well as their course, branching pattern and anastomoses, external diameters, and neighboring vascular and nervous structures were recorded. Microanatomical dissections were performed using the surgical microscope. In addition, 8 surgical cases in which the far-lateral approach was used were collected prospectively to record the course and origin of the PSA. Altogether, a total of 34 sides were analyzed for their PSA origin and course. RESULTS In the cadaveric specimens, the PSA was found to originate from the vertebral artery (VA) in 25 sides (96%). In 13 specimens (50%) the PSA originated from the V(4) segment of the VA intradurally. In 12 specimens (46%) the PSA originated from the V(3) segment of the VA extradurally. In 1 specimen (4%), in whom the posterior inferior cerebellar artery (PICA) had an early origin from the VA extradurally at the C-1 level, the PSA originated from the PICA. Of the 8 surgical cases, 2 patients had extradural origin of the PSA from the V(3) segment of the VA, whereas 6 patients had intradural origin of the PSA from the V(4) segment. CONCLUSIONS Although the usual origin of the PSA is from the VA either intra- or extradurally, its origin is closely related to the origin of the PICA. The PSA originates from the PICA in cases in which the PICA originates extradurally from the VA. In the far-lateral transcondylar approach, the dura is opened in close proximity to the VA. Knowledge of the origin and course of the PSA is critically important when executing the far-lateral approach to avoid its injury.
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Affiliation(s)
- Hakan Seçkin
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
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Partial anterior cervical cord infarction following vertebral artery dissection. Can J Neurol Sci 2009; 35:674-7. [PMID: 19235459 DOI: 10.1017/s0317167100009549] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Leys D, Debette S, Lucas C, Leclerc X. Cervical artery dissections. HANDBOOK OF CLINICAL NEUROLOGY 2009; 93:751-765. [PMID: 18804678 DOI: 10.1016/s0072-9752(08)93037-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Didier Leys
- Department of Neurology, Stroke Unit, Roger Salengro Hospital, University of Lille, Lille, France.
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Tabatabai G, Schöber W, Ernemann U, Weller M, Krüger R. Vertebral artery dissection presenting with ispilateral acute C5 and C6 sensorimotor radiculopathy: A case report. CASES JOURNAL 2008; 1:139. [PMID: 18768083 PMCID: PMC2538503 DOI: 10.1186/1757-1626-1-139] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 09/03/2008] [Indexed: 11/10/2022]
Abstract
Spinal manifestations of vertebral artery dissection (VAD) are rare events and are typically symptomatic with neck pain and ischemic brain injury. We report a patient presenting with unusual peripheral paresis of the right upper limb due to an intramural hematoma of the right vertebral artery with local compression of C5 and C6 as the cause of cervical radiculopathy. These symptoms completely resolved after anticoagulation and physical therapy.
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Affiliation(s)
- Ghazaleh Tabatabai
- Center of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.
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Blanc R, Hosseini H, Le Guerinel C, Brugières P, Gaston A. Posterior cervical spinal cord infarction complicating the treatment of an intracranial dural arteriovenous fistula embolization. J Neurosurg Spine 2006; 5:79-82. [PMID: 16850963 DOI: 10.3171/spi.2006.5.1.79] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Acute ischemic infarction of the posterolateral bulbomedullary junction occurred in a 28-year-old man who underwent arterial embolization for the treatment of an intracranial dural arteriovenous malformation. The migration of the embolic agent in the posterior spinal artery via a peripheral anastomosis between the middle meningeal artery and the posterior meningeal artery was responsible for this complication. The cast of glue in the radiculopial system at the upper cervical level was visible on computed tomography scanning, and magnetic resonance imaging demonstrated circumscribed signal changes and restricted diffusion in the arterial territory of the bulbomedullary junction. The authors discuss the anatomical, clinical, and technical issues of this rare complication.
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Affiliation(s)
- Raphaël Blanc
- Department of Neuroradiology, Assistance Publique Hôpitaux de Paris, Centre Hospitalier Universitaire, Henri Mondor, Créteil Cedex, France.
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Ito S, Hattori T, Kanesaka T, Asahina M. Posterior spinal artery syndrome presenting with sensory and motor disturbances of unilateral lower limb. J Neurol 2005; 252:850-1. [PMID: 15765198 DOI: 10.1007/s00415-005-0758-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Revised: 11/21/2004] [Accepted: 11/24/2004] [Indexed: 10/25/2022]
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Abstract
Traditional data and recent advances in the field of spinal cord ischemia are reviewed, with special attention to clinical and radiological features, as well as underlying etiology, outcome, and pathophysiology. Acute spinal cord ischemia includes arterial and venous infarction and global ischemia resulting from cardiac arrest or severe hypotension. MRI has become the technique of choice for the imaging diagnosis of spinal cord infarction. Correlation of clinical and MRI data has allowed diagnosis of clinical syndromes due to small infarcts in the central or peripheral arterial territory of the spinal cord. Diffusion-weighted MR imaging may increase the sensitivity and specificity for diagnosis of acute spinal cord infarction. Diagnosis of venous spinal cord infarction remains difficult. As for global ischemia, neuropathological studies demonstrated a great sensitivity of spinal cord to ischemia, with selective vulnerability of lumbosacral neurons. Chronic spinal cord ischemia results in a syndrome of progressive myelopathy. The cause is usually an arteriovenous malformation. Most often, diagnosis may be suspected on MRI, leading to diagnostic, and eventually therapeutic, spinal angiography.
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Affiliation(s)
- C Masson
- Service de Neurologie, Hôpital Beaujon, Clichy, France.
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Suzuki T, Kawaguchi S, Takebayashi T, Yokogushi K, Takada J, Yamashita T. Vertebral body ischemia in the posterior spinal artery syndrome: case report and review of the literature. Spine (Phila Pa 1976) 2003; 28:E260-4. [PMID: 12838116 DOI: 10.1097/01.brs.0000067285.39466.fb] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case of posterior spinal cord syndrome in which magnetic resonance images showed predominant T2 hyperintense signal in the adjacent vertebral body is reported. OBJECTIVES To present the case for abnormal bone marrow magnetic resonance signal in the radiologic diagnosis of posterior spinal cord syndrome and to review its significance. SUMMARY OF BACKGROUND DATA Infarction in the region of posterior spinal arteries has been rarely described. This is attributable not only to the infrequent occurrence of infarction of posterior spinal arteries, but also to a lack of well-established diagnostic procedures. It is of clinical value to define diagnostic images of posterior spinal cord syndrome, especially early in the course of the disease. METHODS The subject was a 52-year-old man who was presented with acute nontraumatic myelopathy. Magnetic resonance imaging, performed serially after onset of the disorder from 5 hours to 11 months, was evaluated in comparison with neurologic findings. The literature was reviewed to discuss the magnetic resonance images of spinal cord infarction. RESULTS The neurologic findings were consistent with posterior spinal cord syndrome. A magnetic resonance image taken at 5 hours after onset of the syndrome showed T2 hyperintense signal in the T12 vertebral body. At 3 days after onset, T2 hyperintense signal became obvious in the posterior portion of the spinal cord at T9-T12 vertebral levels. Follow-up magnetic resonance imaging at 41 days, 8 months, and 11 months showed a decrease in the size and intensity of the T2 signal change in the spinal cord and T12 vertebral body. In the literature, T2 hyperintense bone marrow signal was defined in one case of posterior spinal cord syndrome and seven cases of anterior spinal cord syndrome. CONCLUSIONS Associated bone marrow abnormalities likely reflect the underlying pathology of the blood supply to the vertebral body, and may be an additional key sign for radiologic diagnosis of posterior spinal cord syndrome.
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Affiliation(s)
- Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
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Kawabata H, Matsui Y, Kitano M. Magnetic resonance angiography of the forearm and hand in children. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2001; 6:157-62. [PMID: 11901461 DOI: 10.1142/s021881040100062x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2001] [Accepted: 05/14/2001] [Indexed: 11/18/2022]
Abstract
A two-dimensional time-of-flight magnetic resonance angiography was performed in 29 arms in 25 pediatric patients with congenital hand abnormalities, whose average age was three years and eight months. Venous structures were eliminated with presaturation technique and the remaining arterial system was evaluated. Magnetic resonance angiography demonstrated major arteries in the forearm well but not their branches. Even the biggest branch of the artery sometimes could not be detected. Magnetic resonance angiography and Allen test were consistent in determining patency of the palmar arch in 62% of the cases but the sensitivity was only 28%. Our experience showed that non-invasive, convenient, two-dimensional time-of-flight magnetic resonance angiography was useful for detecting continuity and spatial localisation of the major arteries in a child's forearm. However, it was not a complete alternative to conventional angiography and was unsatisfactory in delineating the vascular anatomy in the hand.
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Affiliation(s)
- H Kawabata
- Department of Orthopaedic Surgery, Osaka Medical Centre and Research Institute for Maternal and Child Health, Japan.
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Abstract
Among 111 patients with vertebral artery dissection (VAD), two presented with spinal manifestations: one with a C5-C6 radiculopathy and the other with a cervical myelopathy. Of 13 previously reported cases of spinal manifestations of VAD (mean age 37 years), ischemic cervical myelopathy was noted in seven; cervical radiculopathy, often at C5-C6 and primarily motor, in five; and hemorrhagic complications in one, with chest pain being part of the presentation.
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Affiliation(s)
- B Crum
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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28
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Weidauer S, Nichtweiß M, Claus D. Spontane bilaterale Vertebralisdissektionen. Clin Neuroradiol 1999. [DOI: 10.1007/bf03043339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Hundsberger T, Thömke F, Hopf HC, Fitzek C. Symmetrical Infarction of the Cervical Spinal Cord Due to Spontaneous Bilateral Vertebral Artery Dissection. Stroke 1998. [DOI: 10.1161/01.str.29.8.1742] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Clemens Fitzek
- Klinik für Neuroradiologie, Johannes Gutenberg-Universität Mainz, Mainz, Germany
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