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Zhang L, He L, Huang J, Ren S, Wang J. Transverse spinal cord infarction following immunoglobulin treatment in a patient with exfoliative dermatitis: A case report. Medicine (Baltimore) 2024; 103:e37719. [PMID: 38608119 PMCID: PMC11018161 DOI: 10.1097/md.0000000000037719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/05/2024] [Indexed: 04/14/2024] Open
Abstract
RATIONALE Transverse spinal cord infarction (SCI) is rare but highly disabling. Aortic thrombosis was described as one of the most common etiologies. Thromboembolic complications associated with intravenous immunoglobulin (IVIG) have been reported. PATIENT CONCERNS A previously well, 64-year-old man who was given the treatment of IVIG (0.4 g/kg/d for 5 days) for exfoliative dermatitis 2 weeks before, progressively developed flaccid paraplegia of lower extremities, loss of all sensations below T3 level and urinary incontinence within 50 minutes. DIAGNOSES A diagnosis of SCI and pulmonary embolism was made. IVIG was considered the possible cause. INTERVENTIONS Anticoagulation treatment and continuous rehabilitation were administered. OUTCOMES The neurologic deficiency of the patient was partially improved at the 3-year follow-up. LESSONS The rapid development of severe deficits within 4 hours mostly contributes to the diagnosis of SCI. Heightened awareness of possible thrombotic events is encouraged for a month-long period following IVIG therapy.
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Affiliation(s)
- Lili Zhang
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Lanying He
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Jing Huang
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Sixie Ren
- Department of Medical Imaging, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Jian Wang
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
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2
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Tan YJ, Teo TL, Yeo CL. Cervical posterior spinal artery infarction causing partial Brown-Sequard syndrome. QJM 2023; 116:787-788. [PMID: 37228074 DOI: 10.1093/qjmed/hcad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Y-J Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital Campus, Outram Road, 169608 Singapore, Singapore
- Neuroscience ACP, Duke-NUS Medical School, Singapore
| | - T L Teo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital Campus, Outram Road, 169608 Singapore, Singapore
| | - C L Yeo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital Campus, Outram Road, 169608 Singapore, Singapore
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Benet A, Suzuki Y, Noda K, Tanikawa R. Occipital Artery to Posterior Medullary Artery Bypass During Clipping of a Dissecting V4 Vertebral Artery Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e104-e105. [PMID: 37195049 DOI: 10.1227/ons.0000000000000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 05/18/2023] Open
Affiliation(s)
- Arnau Benet
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Stroke Center, Sapporo, Hokkaido, Japan
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Yosuke Suzuki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Stroke Center, Sapporo, Hokkaido, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Stroke Center, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Stroke Center, Sapporo, Hokkaido, Japan
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Panesar H, Conry A, Finocchi V, Desai C, Bracewell RM. Posterior spinal artery infarct. Pract Neurol 2023; 23:160-163. [PMID: 36863868 DOI: 10.1136/pn-2021-003336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 03/04/2023]
Abstract
Posterior spinal artery syndrome has a variable presentation and often poses a clinical challenge. We describe an acute posterior spinal artery syndrome in a man in his 60s with vascular risk factors, who presented with altered sensation in the left arm and left side of his torso but with normal tone, strength and deep tendon reflexes. MR imaging showed a left paracentral T2 hyperintense area affecting the posterior spinal cord at the level of C1. Diffusion-weighted MRI (DWI) showed high signal intensity in the same location. He was medically managed as having ischaemic stroke and made a good recovery. Three-month MRI follow-up showed a persisting T2 lesion but the DWI changes had resolved, consistent with the time course for infarction. Posterior spinal artery stroke has a variable presentation and is probably under-recognised clinically, requiring careful attention to MR imaging for its diagnosis.
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Affiliation(s)
- Harrypal Panesar
- Radiology, Nobles Hospital, Douglas, Isle of Man
- Radiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Aoife Conry
- Medicine, Nobles Hospital, Braddan, Isle of Man
| | | | - Chaitya Desai
- Radiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Robert Martyn Bracewell
- Bangor University, Bangor, UK
- Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Vlašković T, Brkić BG, Stević Z, Kostić D, Stanisavljević N, Marinković I, Vojvodić A, Nikolić V, Puškaš L, Blagojević M, Marinković S. Anatomic and MRI bases for medullary infarctions with patients' presentation. J Stroke Cerebrovasc Dis 2022; 31:106730. [PMID: 36029688 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/31/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE There is a low incidence of the medullary infarctions and sparse data about the vascular territories, as well as a correlation among the anatomic, magnetic resonance imaging (MRI) and neurologic signs. MATERIALS AND METHODS Arteries of the 10 right and left sides of the brain stem were injected with India ink, fixed in formalin and microdissected. The enrolled 34 patients with medullary infarctions underwent a neurologic, MRI and Doppler examination. RESULTS Four types of the infarctions were distinguished according to the involved vascular territories. The isolated medial medullary infarctions (MMIs) were present in 14.7%. The complete MMIs comprised one bilateral infarction (2.9%), whilst the incomplete and partial MMIs were observed in 5.9% and 8.9%, respectively. The anterolateral infarctions (ALMIs) were very rare (2.9%). The complete and incomplete lateral infarctions (LMIs), noted in 35.3%, comprised 11.8% and 23.6%, respectively, that is, the anterior (5.9%), posterior (8.9%), deep (2.9%), and peripheral (5.9%). Dorsal ischemic lesions (DMIs) occurred in 11.8%, either as a complete (2.9%), or isolated lateral (5.9%) or medial infarctions (2.9%). The remaining ischemic regions belonged to various combined infarctions of the MMI, ALMI, LMI and DMI (35.3%). The infarctions most often affected the upper medulla (47.1%), middle (11.8%), or both (29.5%). Several motor and sensory signs were manifested following infarctions, including vestibular, cerebellar, ocular, sympathetic, respiratory and auditory symptoms. CONCLUSIONS There was a good correlation among the vascular territories, MRI ischemia features, and neurologic findings regarding the medullary infarctions.
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Affiliation(s)
- Tatjana Vlašković
- Psychiatrist, University of Belgrade, Faculty of Medicine, Laza Lazarević Hospital of Psychiatry, Faculty of Medicine, Belgrade, Serbia
| | - Biljana Georgievski Brkić
- Associate Researcher of Radiology, University of Belgrade, Faculty of Medicine, Sveti Sava Hospital, Department of CT and MRI, Belgrade, Serbia
| | - Zorica Stević
- Professor of Neurology, University of Belgrade, Faculty of Medicine, Clinical Center, Clinic of Neurology
| | - Dejan Kostić
- Assistant Professor of Radiology, Military Medical Academy, Institute of Radiology, Belgrade, Serbia
| | - Nataša Stanisavljević
- Hematologist, University of Belgrade, Clinical Hospital Center Bezanijska Kosa, Department of Hematology, Belgrade, Serbia
| | - Ivan Marinković
- Neurologist, Clinical Neuroscience, Neurology, Helsinki University Central Hospital, University of Helsinki, Finland.
| | - Aleksandra Vojvodić
- Teaching Assistant in Dermatovenerology, University of Belgrade, Media Group Hospital, Belgrade, Serbia
| | - Valentina Nikolić
- Professor of Anatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia
| | - Laslo Puškaš
- Professor of Anatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia
| | - Miloš Blagojević
- Associate Professor of Anatomy, University of Belgrade, Faculty of Veterinary Medicine, Institute of Anatomy, Belgrade, Serbia
| | - Slobodan Marinković
- Professor of Neuroanatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Department of Neuroanatomy, Belgrade, Serbia
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Elshony H, Idris A, Ahmed A, Almaghrabi M, Ahmed W, Fallatah S. Spinal Cord Ischemia Secondary to Aortic Dissection: Case Report with Literature Review for Different Clinical Presentations, Risk Factors, Radiological Findings, Therapeutic Modalities, and Outcome. Case Rep Neurol 2021; 13:634-655. [PMID: 34720966 PMCID: PMC8543361 DOI: 10.1159/000518197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
Aortic dissection (AD) is a serious condition that causes transient or permanent neurological problems that include spinal cord ischemia (SCI), which occurs when AD extends into the descending aorta resulting in insufficient perfusion of segmental arteries that supplies the spinal cord. We report a 64-year-old male, presented with severe back pain, asymmetrical paresthesia, and weakness of both limbs, more in the left lower limb with loss of pinprick, temperature, and fine touch sensation on the lower left lower limb below the level of T5 with preserved proprioception and vibration and urine hesitancy. Computed tomography showed AD, Stanford type A, and spinal magnetic resonance imaging (MRI) showed hyperintense owl's eye sign at T5. The patient was diagnosed as anterior spinal artery syndrome secondary to an AD and referred for aortic surgical repair with good functional outcome. In our review to cases of SCI due to AD, it was more common in males above 55 years, pain only found in 47.8% of patients, with anterior cord syndrome on top of the clinical presentations, and hypertension is the most common risk factor. MRI spine showed thoracic location predominance. Surgical or endovascular repair especially for type A and complicated type B should be considered to avoid complications, and cerebrospinal fluid drainage is a very useful tool in reversing SCI specially if done early with favorable outcome. Only the old age is associated with increased risk of mortality. Early diagnosis and appropriate management are crucial for better outcome.
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Affiliation(s)
- Hosna Elshony
- Department of Neuropsychiatry, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Abdelrahman Idris
- Department of Neurology/Internal medicine, Security Forces Hospital, Makkah, Saudi Arabia
| | - Alaa Ahmed
- Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Walaa Ahmed
- Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Shouq Fallatah
- Faculty of Medicine, Taif University, Taif, Saudi Arabia
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7
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Caplan LR, Chang YM. Severe Unilateral Proprioceptive Loss in Medullary- Rostral Spinal Cord Infarction. A Posterior Spinal Artery Syndrome. J Stroke Cerebrovasc Dis 2021; 30:105882. [PMID: 34077822 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
We draw attention to a unique presentation, severe unilateral loss of limb proprioception, in patients with medullary and rostral spinal cord infarction. Two patients developed acute severe proprioceptive loss in the limbs ipsilateral to infarcts that involved the caudal medulla and rostral spinal cord. They also had symptoms and signs often found in lateral medullary infarction. The proprioceptive loss is attributable to injury to the gracile and cuneate nuclei and/or their projections to the medial lemniscus. The infarct territory is supplied by the posterior spinal branches of the vertebral artery near its penetration into the posterior fossa. The presence of severe ipsilateral proprioceptive loss in a patient with features of lateral medullary infarction indicates involvement of the rostral spinal cord.
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Affiliation(s)
- Louis R Caplan
- Beth Israel Deaconess Medical center, 330 Brookline Ave, Boston, MA 02215, USA.
| | - Yu-Ming Chang
- Beth Israel Deaconess Medical Center, Department of Radiology, 330 Brookline Avenue, Boston, MA 02215-5400, USA
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Abstract
Vascular disorders of the spinal cord are uncommon yet under-recognized causes of myelopathy. Etiologies can be predominantly categorized into clinical and radiographic presentations of arterial ischemia, venous congestion/ischemia, hematomyelia, and extraparenchymal hemorrhage. While vascular myelopathies often produce significant morbidity, recent advances in the understanding and recognition of these disorders should continue to expedite diagnosis and proper management, and ideally improve patient outcomes. This article comprehensively reviews relevant spinal cord vascular anatomy, clinical features, radiographic findings, treatment, and prognosis of vascular disorders of the spinal cord.
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Park D, Kim BH, Lee SE, Park JK, Cho JM, Kwon HD, Lee SY. Spinal Cord Infarction: A Single Center Experience and the Usefulness of Evoked Potential as an Early Diagnostic Tool. Front Neurol 2020; 11:563553. [PMID: 33192998 PMCID: PMC7652817 DOI: 10.3389/fneur.2020.563553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Spinal cord infarction (SCI) is a rare disease and its early diagnosis is challenging. Here, we described the clinical features and imaging findings of SCI, and assessed the results of evoked potential (EP) studies to elucidate their diagnostic role in the early stage of SCI. Methods: We retrospectively analyzed 14 patients who had spontaneous SCI. The demographic, neurological, and temporal profiles of the SCI patients were identified. We reviewed the imaging findings and assessed the changes in them over time. To review EP, central motor conduction time (CMCT) and somatosensory evoked potential (SEP) values were obtained. We also enrolled 15 patients with transverse myelitis (TM), and compared the clinical, radiological and electrophysiological features between SCI and TM patients. Results: The ages of the SCI patients ranged from 54 to 73 years. Nine patients (64.3%) showed nadir deficits within 6 h. The most common type of clinical visit was via the emergency center. Nine patients (64.3%) presented with peri-onset focal pain. The median initial modified Rankin scale score was 3. For 9 patients (64.3%), initial T2 imaging findings were negative, but subsequent diffusion weighed imaging (DWI) showed diffusion restriction. Vertebral body infarction was observed in 5 patients (35.7%). EP data were available for 10 SCI patients. All 8 patients who had their CMCT measured showed abnormalities. Among them, motor evoked potentials were not evoked in 6 patients at all. SEP was measured in 10 patients, and 9 of them showed abnormalities; one of them showed no SEP response. For 5 patients, the EP studies were done prior to DWI, and all the patients showed definite abnormalities. The abnormalities in the EP findings of the SCI patients were more profound than those of the TM patients, even though the duration from the onset to the start of the study was much shorter for SCI patients. Conclusion: SCI can be diagnosed based on typical clinical manifestations and appropriate imaging studies. Our study also indicates that immediate sensory and motor EP study can have an adjuvant diagnostic role in the hyperacute stage of SCI, and can improve the accuracy of diagnosis.
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Affiliation(s)
- Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang-si, South Korea
| | - Byung Hee Kim
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang-si, South Korea
| | - Sang Eok Lee
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang-si, South Korea
| | - Ji Kang Park
- Department of Radiology, Pohang Stroke and Spine Hospital, Pohang-si, South Korea
| | - Jae Man Cho
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang-si, South Korea
| | - Heum Dai Kwon
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang-si, South Korea
| | - Su Yun Lee
- Department of Neurology, Pohang Stroke and Spine Hospital, Pohang-si, South Korea
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10
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Cochrane M, Hess M, Sajkowicz N. Posterior cord syndrome associated with postoperative seroma: The case to perform a complete neurologic exam. J Spinal Cord Med 2020; 43:892-894. [PMID: 30547736 PMCID: PMC7801031 DOI: 10.1080/10790268.2018.1550598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Context: Posterior cord syndrome (PCS) is the least common incomplete spinal cord injury. Findings of posterior cord syndrome include loss of proprioception and vibration, which are not routinely tested with the American Spinal Cord Injury Association's International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam and can easily be missed. Seromas may develop after spinal instrumentation and can cause cord compression. Findings: This case describes a unique presentation of posterior cord syndrome following a large seroma formation after laminectomy. A patient developed ataxia with functional decline following posterior laminectomy. Examination revealed loss of vibration and proprioception in the extremities with preservation of strength. Imaging of the cervical spine demonstrated a large fluid collection at the laminectomy site causing cord compression. The fluid collection was thought to represent a seroma based on clinical presentation, imaging, and laboratory testing. The patient was admitted to inpatient rehabilitation with improvement in function allowing discharge to home. Conclusion/clinical relevance: Seromas are a complication following cervical instrumentation that can cause compression of the adjacent spinal cord resulting in functional decline. The seroma, in this case, led to the loss of vibration and proprioception with resultant ataxia, signs that are not routinely identified on ISNCSCI exam; therefore, this highlights the need to broaden the neurological examination when evaluating a patient with spinal cord injury who has experienced a neurological setback.
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Affiliation(s)
- Meghan Cochrane
- Department of Spinal Cord Injury Medicine, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Marika Hess
- Department of Spinal Cord Injury Medicine, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Natalie Sajkowicz
- Physical Medicine and Rehabilitation Department, Tufts Medical Center, Boston, Massachusetts, USA
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11
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Konno M, Kanbayashi T, Hamada Y, Yamamoto J, Furukawa Y, Hatanaka Y, Sonoo M. [Hemiplegia cruciata and severe facial pain due to infarction of the cervicomedullary junction: a case report]. Rinsho Shinkeigaku 2020; 60:693-698. [PMID: 32893244 DOI: 10.5692/clinicalneurol.cn-001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report the case of a 66-year-old female with hemiplegia cruciata and severe facial pain due to infarction of the cervicomedullary junction. She presented to the hospital with complaints of acute-onset left facial pain and gait disturbance. Neurological examination revealed narrow left palpebral fissure, severe left facial pain and hypothermoesthesia, weakness predominantly in the left upper and right lower extremities, decreased pain and temperature sensation in the right lower extremity, decreased vibration sensation in the left lower extremity, hyperreflexia in the left upper extremity, and mild ataxia in the left upper and lower extremities. Brain MRI revealed a high-intensity lesion in the left cervicomedullary junction on diffusion-weighted and fluid-attenuated inversion recovery images. Hemiplegia cruciata due to the pyramidal tract injury at the cervicomedullary junction is an uncommon clinical manifestation. However, in patients with hemiplegia cruciata, identifying the lesion location may be difficult. Clinicians should consider the possibility of pyramidal decussation lesions. Anatomical differences, in the course of pyramidal tract fibers between the upper and lower limbs have been considered in the pyramidal decussation. Hemiplegia cruciata in this case was primarily caused by the impairment of the left upper limb pyramidal fibers after the pyramidal decussation and the right lower limb pyramidal fibers before the pyramidal decussation.
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Affiliation(s)
- Masahiro Konno
- Department of Neurology, Teikyo University School of Medicine
| | | | - Yuichi Hamada
- Department of Neurology, Teikyo University School of Medicine
| | - Junpei Yamamoto
- Department of Neurology, Teikyo University School of Medicine
| | - Yuichi Furukawa
- Department of Neurology, Teikyo University School of Medicine
| | - Yuki Hatanaka
- Department of Neurology, Teikyo University School of Medicine
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine
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12
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Chen F, Liu X, Qiu T, Jia C, Liu M, Jin Q, Gao P, Li X. Cervical Posterior Spinal Artery Syndrome Caused By Spontaneous Vertebral Artery Dissection: Two Case Reports and Literature Review. J Stroke Cerebrovasc Dis 2020; 29:104601. [PMID: 31917091 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022] Open
Abstract
Herein, we described 2 patients with posterior spinal artery syndrome (PSAS) caused by vertebral artery dissection. The patients complained of sudden neck pain or walking instability. Neurological examination revealed sensory loss, muscle weakness, and sensory ataxia. Angiography showed double lumen sign or intimal flap in the vertebral artery. T2-weighted imaging and diffusion-weighted imaging of MRI showed a hyperintense lesion in the dorsal side of the cervical spinal cord at different times after onset. Both patients had good outcome after antiplatelet therapy and physiotherapy. A review of previously reported PSAS cases was also conducted in order to improve the understanding and awareness of this rare myelopathy.
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Affiliation(s)
- Futao Chen
- Graduate School, Shandong First Medical University & Shandong Academy of Medical Science, TaiAn, China
| | - Xuemeng Liu
- Department of Neurosurgery, FeiXian People Hospital, FeiXian, China
| | - Tiantian Qiu
- Department of Radiology, LinYi People's Hospital, LinYi, China
| | - Chunxue Jia
- Graduate School, Shandong First Medical University & Shandong Academy of Medical Science, TaiAn, China
| | - Min Liu
- Department of Radiology, LinYi People's Hospital, LinYi, China
| | - Qianxiu Jin
- Department of Radiology, LinYi People's Hospital, LinYi, China
| | - Peihong Gao
- Department of Radiology, JiNing First People's Hospital, JiNing, China
| | - Xiaodong Li
- Department of Radiology, LinYi People's Hospital, LinYi, China.
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13
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Zalewski NL, Rabinstein AA, Krecke KN, Brown RD, Wijdicks EFM, Weinshenker BG, Kaufmann TJ, Morris JM, Aksamit AJ, Bartleson JD, Lanzino G, Blessing MM, Flanagan EP. Characteristics of Spontaneous Spinal Cord Infarction and Proposed Diagnostic Criteria. JAMA Neurol 2019; 76:56-63. [PMID: 30264146 DOI: 10.1001/jamaneurol.2018.2734] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Spinal cord infarction (SCI) is often disabling, and the diagnosis can be challenging without an inciting event (eg, aortic surgery). Patients with a spontaneous SCI are often misdiagnosed as having transverse myelitis. Diagnostic criteria for SCI are lacking, hindering clinical care and research. Objective To describe the characteristics of spontaneous SCI and propose diagnostic criteria. Design, Setting, and Participants An institution-based search tool was used to identify patients evaluated at Mayo Clinic, Rochester, Minnesota, from January 1997 to December 2017 with a spontaneous SCI. Patients provided written consent to use their records for research. Participants were 18 years and older with a diagnosis of spontaneous SCI (n = 133), and controls were selected from a database of alternative myelopathy etiologies for validation of the proposed diagnostic criteria (n = 280). Main Outcomes and Measures A descriptive analysis of SCI was performed and used to propose diagnostic criteria, and the criteria were validated. Results Of 133 included patients with a spontaneous SCI, the median (interquartile range) age at presentation was 60 (52-69) years, and 101 (76%) had vascular risk factors. Rapid onset of severe deficits reaching nadir within 12 hours was typical (102 [77%]); some had a stuttering decline (31 [23%]). Sensory loss occurred in 126 patients (95%), selectively affecting pain/temperature in 49 (39%). Initial magnetic resonance imaging (MRI) spine results were normal in 30 patients (24%). Characteristic MRI T2-hyperintense patterns included owl eyes (82 [65%]) and pencil-like hyperintensity (50 [40%]); gadolinium enhancement (37 of 96 [39%]) was often linear and located in the anterior gray matter. Confirmatory MRI findings included diffusion-weighted imaging/apparent diffusion coefficient restriction (19 of 29 [67%]), adjacent dissection/occlusion (16 of 82 [20%]), and vertebral body infarction (11 [9%]). Cerebrospinal fluid showed mild inflammation in 7 of 89 patients (8%). Diagnostic criteria was proposed for definite, probable, and possible SCI of periprocedural and spontaneous onset. In the validation cohort (n = 280), 9 patients (3%) met criteria for possible SCI, and none met criteria for probable SCI. Conclusions and Relevance This large series of spontaneous SCIs provides clinical, laboratory, and MRI clues to SCI diagnosis. The diagnostic criteria proposed here will aid clinicians in making the correct diagnosis and ideally improve future care for patients with SCI. The validation of these criteria supports their utility in the evaluation of acute myelopathy.
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Affiliation(s)
| | | | - Karl N Krecke
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | - J D Bartleson
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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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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15
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Hsu JL, Cheng MY, Liao MF, Hsu HC, Weng YC, Chang KH, Chang HS, Kuo HC, Huang CC, Lyu RK, Lin KJ, Ro LS. The etiologies and prognosis associated with spinal cord infarction. Ann Clin Transl Neurol 2019; 6:1456-1464. [PMID: 31402616 PMCID: PMC6689689 DOI: 10.1002/acn3.50840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study aims to investigate the etiology and prognosis of spinal cord infarction (SCI). METHODS Over a period of 16 years, we retrospectively analyzed 31 patients with SCI. Demographic features and symptom presentations were carefully documented. Etiology-specific MRI features, such as the length and distribution of the lesions and owl's eyes sign, were recorded and analyzed to determine their associations with the clinical signs/symptoms. RESULTS In total, seven patients had aortic or vertebral artery dissections. We divided the patients with SCI into two groups: those with or without vessel dissection. Among SCI patients, the onset age was younger, and the proportion of patients with long-segment lesions and posterior pattern involvement on axial view was higher in the group with dissection than in the group without dissection (all P < 0.05). The lesions were frequently located in the upper cervical or lower thoracic-lumbar regions, and the lengths of the lesions were associated with 1-month outcomes, suggesting that artery dissection may contribute to the longitudinal and posterior extension of SCI. In contrast, among patients without dissection, the range of longitudinal extensions of in spans of vertebral bodies was broader (range, 1-8). A higher proportion of patients had focal pain adjacent to the lesion (P = 0.05) and a poorer 1-month outcome (P = 0.04) in the long-segment lesion group than in the short-segment lesion group. CONCLUSIONS A detailed history and the use of modern imaging tools may help clinicians search for vessel dissection and other etiologies, evaluate the spatial extension of lesions in SCI, and predict prognosis.
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Affiliation(s)
- Jung Lung Hsu
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Mind, Brain, and Consciousness, Taipei Medical University, Taipei, Taiwan.,Brain and Consciousness Research Center, TMU Shuang Ho Hospital, New Taipei City, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Ming-Feng Liao
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Ching Hsu
- Department of Traditional Chinese Medicine, Division of Chinese Acupuncture and Traumatology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Weng
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hong-Shiu Chang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chou Kuo
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chang Huang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Rong-Kuo Lyu
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Ju Lin
- Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Long-Sun Ro
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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16
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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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17
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Zalewski NL, Rabinstein AA, Wijdicks EF, Petty GW, Pittock SJ, Mantyh WG, Flanagan EP. Spontaneous posterior spinal artery infarction. Neurology 2018; 91:414-417. [DOI: 10.1212/wnl.0000000000006084] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/18/2018] [Indexed: 11/15/2022] Open
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18
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Elzamly K, Nobleza C, Parker E, Sugg R. Unilateral Upper Cervical Posterior Spinal Cord Infarction after a Neuroendovascular Intervention: A Case Report. Case Rep Neurol Med 2018; 2018:5070712. [PMID: 30073102 PMCID: PMC6057308 DOI: 10.1155/2018/5070712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/12/2018] [Accepted: 06/20/2018] [Indexed: 11/19/2022] Open
Abstract
CONTEXT We describe a case of unilateral posterior upper cervical spinal cord infarction and propose a pathophysiologic mechanism causing this lesion after vertebral artery endovascular intervention. FINDINGS A 70-year-old male presented with subacute onset of left hemibody sensory changes and gait instability following a left vertebral angioplasty procedure. MRI cervical spine revealed upper posterior cervical spinal cord infarction (PSCI). After 3 months patient had substantial improvement of his symptoms. CONCLUSION PSCI is rare but can present as a complication from vertebral artery angioplasty procedure. Early diagnosis of PSCI can be achieved with adequate understanding of its clinical signs and the blood supply of the spinal cord.
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Affiliation(s)
- Kareem Elzamly
- Department of Neurology, University of Mississippi Medical Center, Jackson, USA
| | - Christa Nobleza
- Department of Neurology, University of Mississippi Medical Center, Jackson, USA
| | - Ellen Parker
- Department of Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Rebecca Sugg
- Department of Neurology, University of Mississippi Medical Center, Jackson, USA
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19
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Chandra A, Li WA, Stone CR, Geng X, Ding Y. The cerebral circulation and cerebrovascular disease I: Anatomy. Brain Circ 2017; 3:45-56. [PMID: 30276305 PMCID: PMC6126264 DOI: 10.4103/bc.bc_10_17] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/28/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022] Open
Abstract
In this paper, which is the first in a three-part series that reviews cerebrovascular anatomy, pathogenesis, and stroke, we lay the anatomical foundation for the rest of the series. Beginning with its origin in the branches of the aorta, we start by describing the arterial system. This system is partitioned into two major divisions (anterior and posterior circulations) that differ significantly in features and pathogenic potential. The systems, and the major branches that comprise them, are described. Description of the arterial system proceeds to the point of the fulfillment of its function. This function, the exchange of gases and nutrients with the cerebral parenchyma, is the subject of a subsequent section on the microcirculation and blood-brain barrier. Finally, the cerebral venous system, which is composed of cerebral veins and dural venous sinuses, is described. Thus, an anatomical context is supplied for the discussion of cerebrovascular disease pathogenesis provided by our second paper.
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Affiliation(s)
- Ankush Chandra
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - William A Li
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christopher R Stone
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
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