Subclavian artery stenosis causing transient bilateral brachial diplegia: an unusual cause of anterior spinal artery syndrome

Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend?

The cervical anterior spinal artery (ASA) is a very important artery arising from the intracranial vertebral artery (VA). It can play different roles in endovascular treatment (EVT) of spinal vascular diseases. The current understanding of these roles is incomplete; therefore, we performed this review. We found that cervical ASA can be involved in many spinal vascular diseases, such as arteriovenous fistula (AVF), arteriovenous malformation (AVM), and aneurysm, and can serve as a collateral channel in proximal VA occlusion. In AVF and AVM, when the cervical ASA is involved, it often plays the role of an accomplice or victim because it acts as the feeder or as a bystander that does not provide blood flow to the AVF and AVM. In cervical ASA aneurysm, the ASA is a victim. During EVT of VA aneurysms or stenoses, the cervical ASA ostia can be covered or occluded, resulting in ASA ischemia. In this situation, the ASA is a victim. In VA occlusion or the subclavian steal phenomenon, the cervical ASA can serve as a collateral channel to provide blood flow to the posterior circulation. In this case, the ASA plays the role of a friend. According to the role of the cervical ASA in spinal vascular diseases, EVT should be determined “case by case.” Most importantly, when EVT is performed to treat these diseases, the cervical ASA axis must be preserved. Therefore, understanding the role of the cervical ASA in spinal vascular diseases is crucial.

Pediatric spinal cord infarct: a rare cause of a rare disorder, (wo)man in barrel syndrome

The "man in barrel syndrome" is a condition which resembles the aspect of patient being constrained in a barrel in which patient presents with bilateral upper limb weakness. It has classically been attributed to supratentorial lesions in watershed zones. We present such a case in a 12-year-old child who presented with bibrachial weakness and was noted to have cervical cord infarct on imaging. Spinal cord infarct is a rare cause of this syndrome, and until now only 20 cases have been described in which cervical cord infarct led to this presentation, all of them being adults. We describe first case report of bibrachial diplegia due to cord infarct in a child. Our case adds to the limited literature of cervical cord ischemia as a cause of "(wo) man in barrel syndrome" and re-iterates the fact that imaging of cervical cord should be considered while evaluating these cases.

Case Report: An Unusual Presentation of Bilateral Subclavian Stenosis in a Patient with Asymptomatic Hypotension

Patient: Male, 63

Final Diagnosis: Bilateral subclavian artery stenosis

Symptoms: Hypotension

Medication: —

Clinical Procedure: —

Specialty: General and Internal Medicine

Anterior spinal artery syndrome presenting as cervical myelopathy in a patient with subclavian steal syndrome

The anterior spinal artery syndrome (ASAS), described by Preobraschenski in 1908,¹ is characterized by bilateral spastic paraparesis and dissociated sensory deficits involving bilateral loss of temperature and pain sensation but preserved proprioception and touch. The ASAS typically develops acutely, over minutes to hours. While initially linked to infections, in particular syphilis, many other etiologies are now recognized, including aortic atheromatous disease and thromboembolic phenomenon. We report a case of ASAS in a patient with a steal phenomenon secondary to a right-sided aortic arch with interruption of the left subclavian artery (SCA).

Man-in-the-barrel. A case of cervical spinal cord infarction and review of the literature

Introduction:

Man-in-the-barrel syndrome was initially observed in patients with signs of serious cerebral hypoperfusion, in the border zone of the anterior and medial cerebral artery, but other causes were communicated later.

Methods:

a healthy 43-year-old woman who showed intense cervical pain, irradiating over both shoulders and arms. Physical examination on admission highlighted notable brachial diparesis, tacto-algesic hypoesthesia of both arms and sensory level C4-D9.

Results:

cervical Magnetic Resonance Imaging (MRI) on admission revealed a hyperintense intramedullar lesion at C3-C7 level, due to a cervical cord infarction.

Conclusions:

our case reveals that conventional neurological consideration about the specific anatomical location of man-in-the-barrel syndrome in the brain should be extended to other locations such as the cervical column and not only the brain area.