Abstract 1122‐000032: Spinal Cord Infarction a Young Patient with a Hypoplastic Vertebral Artery

Introduction : Rare presentation of disease processes is absolutely intriguing to the human mind. Spinal cord infarction is abundantly reported to be secondary to cardiological procedures, patients carrying multiple vascular risk factors and vertebral artery dissections. But for it to happen in a patient who is young, relatively healthy and without vascular risk factors is quite interesting. Herein, we present the case of a patient presented with bilateral upper extremity weakness, who has a hypoplastic right vertebral artery that has coincided with him being a professional gamer with exerting compression from video‐gaming posturing of “forward leaning with neck hyperextension”, resulting in cervical spinal cord infarction. Methods : Case report Results : Vertebral artery dissection was excluded by CTA and MRA. our hypothesis was that the patient is a professional gamer and his posture of leaning forward and neck hyper‐extension had a role in inducing his spinal cord infarction given the fact of him having a hypoplastic right vertebral artery. Conclusions : Vertebral artery disease is a well‐recognized cause of ischemia in the posterior cerebral circulation. Recently, however, cervical cord infarction, albeit being extremely rare, has been increasingly reported as a complication of vertebral artery diseases such as dissection. Awareness must be raised that such condition can also happen in the young population due to compression of the vertebral arteries, especially when one is hypoplastic.

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Spinal Cord Ischemia due to Vertebral Artery Dissection

Rivista di Neuroradiologia ◽

10.1177/197140090501800318 ◽

2005 ◽

Vol 18 (3) ◽

pp. 390-394

Author(s):

M. Bergui ◽

G. Ventilii ◽

F.M. Ferrio ◽

D.R. Daniele ◽

G.B. Bradač

Keyword(s):

Spinal Cord ◽

Differential Diagnosis ◽

Vertebral Artery ◽

Grey Matter ◽

Spinal Cord Ischemia ◽

Vertebral Artery Dissection ◽

Cervical Cord ◽

Artery Dissection ◽

Spinal Cord Infarction ◽

Central Regions

We reviewed clinical and neuroradiological findings in 37 consecutive patients with cervical cord infarction due to vertebral artery dissection diagnosed at our institution from 1996 to 2004. Four patients had clinical and neuroradiological findings consistent with spinal cord ischemia. Three patients had “pencil-like” infarction at C3-C5 level; one patient had an infarction of the anterior horns of the spinal grey matter at C3-C4 level. Symptoms were crural sensory deficit with mild tetraparesis and proximal strength deficit of the arms, respectively. Spinal cord infarction complicated vertebral artery dissection in about 10% of patients of our series. Infarctions involved the most central regions of the spinal cord, with relative sparing of the peripheral white matter tracts. Clinical and MRI pictures were almost typical, and consistent with a hemodynamic mechanism for the lesions. Vertebral artery dissection must be considered in the differential diagnosis in patients with cervical cord infarction.

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Endovascular treatment with tirofiban during the acute stage of cervical spinal cord infarction due to vertebral artery dissection

Journal of Spinal Cord Medicine ◽

10.1080/10790268.2017.1422880 ◽

2018 ◽

Vol 43 (1) ◽

pp. 130-133

Author(s):

Yuanling Wu ◽

Wenxian Li ◽

Xiaomei Xie ◽

Zhen Jing ◽

Weibiao Lu ◽

...

Keyword(s):

Spinal Cord ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Cervical Spinal Cord ◽

Vertebral Artery Dissection ◽

Acute Stage ◽

Artery Dissection ◽

Spinal Cord Infarction

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Spinal cord infarction presenting as Brown-Séquard syndrome from spontaneous vertebral artery dissection: a case report and literature review

BMC Neurology ◽

10.1186/s12883-019-1559-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Yang-Yang Meng ◽

Le Dou ◽

Chun-Mei Wang ◽

De-Zheng Kong ◽

Ying Wei ◽

...

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Spinal Cord Infarction ◽

Black Blood ◽

Middle Aged ◽

Aged Patients ◽

Brown Sequard Syndrome

Abstract Background Spinal cord infarction (SCI) is rarely caused by vertebral artery dissection (VAD), which is an important cause of posterior circulation stroke in young and middle-aged patients. We report the case of a middle-aged patient without obvious risk factors for atherosclerosis who had SCI from right VAD. Case presentation An otherwise healthy 40-year-old man presented with acute right-sided body weakness. Six days earlier, he had experienced posterior neck pain without obvious inducement. Neurologic examination revealed a right Brown-Séquard syndrome. Magnetic resonance imaging (MRI) of the head was normal. Further, cervical spine MRI showed spinal cord infarction (SCI) on the right at the C1-C3 level. Three-dimensional high-resolution MRI (3D HR-MRI) volumetric isotropic turbo spin echo acquisition (VISTA) scan showed evidence of vertebral artery dissection (VAD). The patient was significantly relieved of symptoms and demonstrated negative imaging findings after therapy with anticoagulation (AC) and antiplatelets (AP) for 3 months. Conclusions The possibility of vertebral artery dissection (VAD) should be considered in the case of young and middle-aged patients without obvious risk factors for atherosclerosis. Furthermore the VISTA black blood sequence plays an important role in the pathological diagnosis of vertebral artery stenosis. Early correct diagnosis and active therapy are crucial to the prognosis.

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Spinal cord transient ischemic attack

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000778 ◽

2019 ◽

Vol 10 (6) ◽

pp. 480-483 ◽

Cited By ~ 1

Author(s):

Stephen W. English ◽

Alejandro A. Rabinstein ◽

Eoin P. Flanagan ◽

Nicholas L. Zalewski

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Transient Ischemic Attack ◽

Vascular Risk Factor ◽

Vascular Risk Factors ◽

Cervical Cord ◽

Spinal Cord Infarction ◽

Vascular Risk ◽

Risk Factor Modification ◽

Ischemic Attack

ObjectiveTo define the prevalence and characteristics of spinal cord transient ischemic attack (sTIA) in a large retrospective series of patients who met diagnostic criteria for spontaneous spinal cord infarction (SCI).MethodsAn institution-based search tool was used to identify patients evaluated at the Mayo Clinic in Rochester, MN, from 1997 to 2017 with spontaneous SCI (n = 133). Cases were subsequently reviewed for transient myelopathic symptoms preceding infarction that were suspected ischemic in nature. We performed a descriptive analysis of patients with sTIA before SCI.ResultsOf 133 patients with a diagnosis of spontaneous SCI, we identified 4 patients (3%) who experienced sTIA before SCI. The median age at presentation was 61.5 years (range 46–75 years), 2 (50%) were women, and 3 (75%) had traditional vascular risk factors. Localization was cervical cord in 2 cases (50%) and thoracic cord in 2 cases (50%); all patients developed SCI in the same distribution as their preceding sTIA symptoms. All patients experienced recurrent sTIA before SCI. Symptoms ranged from seconds to a few minutes before returning to baseline. No patients had pain as a feature of sTIA.ConclusionssTIAs are possible but rare in patients who subsequently have a SCI. Clinical features are similar to those of SCI, with rapid onset of severe myelopathic deficits, followed by prompt resolution. Vascular risk factors are common in these patients. Thus, recognition of a sTIA may represent a valuable opportunity for vascular risk factor modification and stroke prevention. However, given the rarity, physicians should explore other possible explanations when sTIA is considered.

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Unilateral non traumatic vertebral artery dissection with cervical spinal cord infarction

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2012000200021 ◽

2012 ◽

Vol 70 (2) ◽

pp. 162-162 ◽

Cited By ~ 4

Author(s):

Patricia Gushiken Takahashi ◽

Rubens Gisbert Cury ◽

Camila Galvão Lopes ◽

Mateus Mistieri Simabukuro ◽

Paulo Eurípedes Marchiori

Keyword(s):

Spinal Cord ◽

Vertebral Artery ◽

Cervical Spinal Cord ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Spinal Cord Infarction

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Posterior Cervical spinal cord infarction following vertebral artery dissection

Neurology ◽

10.1212/wnl.48.4.1112 ◽

1997 ◽

Vol 48 (4) ◽

pp. 1112-1114 ◽

Cited By ~ 37

Author(s):

C. A.G. Bergqvist ◽

H. I. Goldberg ◽

O. Thorarensen ◽

S. J. Bird

Keyword(s):

Spinal Cord ◽

Vertebral Artery ◽

Cervical Spinal Cord ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Spinal Cord Infarction

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Unilateral posterior cervical spinal cord infarction due to spontaneous vertebral artery dissection

Journal of Spinal Cord Medicine ◽

10.1179/2045772313y.0000000125 ◽

2013 ◽

Vol 37 (2) ◽

pp. 233-236 ◽

Cited By ~ 11

Author(s):

Sébastien Richard ◽

Chifaou Abdallah ◽

Anne Chanson ◽

Sylvain Foscolo ◽

Pierre-Alexandre Baillot ◽

...

Keyword(s):

Spinal Cord ◽

Vertebral Artery ◽

Cervical Spinal Cord ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Spinal Cord Infarction

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Spinal Cord Infarction in the Region of the Posterior Spinal Artery After Embolization for Vertebral Artery Dissection

Operative Neurosurgery ◽

10.1093/ons/opy026 ◽

2018 ◽

Vol 15 (6) ◽

pp. 701-710 ◽

Cited By ~ 2

Author(s):

Wataro Tsuruta ◽

Tetsuya Yamamoto ◽

Go Ikeda ◽

Masayuki Sato ◽

Yoshiro Ito ◽

...

Keyword(s):

Spinal Cord ◽

Vertebral Artery ◽

Coil Embolization ◽

Univariate Analysis ◽

Posterior Inferior Cerebellar Artery ◽

Vertebral Artery Dissection ◽

Endovascular Surgery ◽

Artery Dissection ◽

Spinal Cord Infarction ◽

Posterior Spinal Artery

AbstractBACKGROUNDEndovascular surgery for vertebral artery dissections (VADs) carries the risk of spinal cord infarction (SCI). Although SCI in the region of the anterior spinal artery (ASA) has been reported, SCI in the region of the posterior spinal artery (PSA) is rare.OBJECTIVETo investigate PSA infarction after endovascular surgery for VAD.METHODSInfarction in the region of the PSA after endovascular surgery for VADs carried out in consecutive 21 cases was investigated. The variables of aneurysmal location, status, intra-aneurysmal thrombosis, antithrombotic therapy, and endovascular procedure were investigated in relation to the occurrence of spinal cord or brain stem infarction.RESULTSThirteen cases were unruptured aneurysms, and 8, ruptured aneurysms. The endovascular surgical method was internal trapping in 10 cases, stent-assisted coil embolization in 8 cases, and proximal occlusion (PO) in 3 cases. Periprocedural symptomatic infarction was detected in 4 of the 21 cases (19%): 3 SCIs and 1 lower medulla infarction, after 1 stent-assisted coil embolization and 3 PO. All 3 symptomatic SCIs were PSA infarction. On univariate analysis, the variables of posterior inferior cerebellar artery-involved-type, PO, and intraprocedural proximal flow arrest were significantly correlated with occurrence of PSA infarction.CONCLUSIONPSA infarction after endovascular surgery for VAD seems not to be a rare potential complication. Insufficiency of collateral blood flow and artery-to-artery embolism due to intraprocedural flow stagnation of the VA seem to be the possible mechanisms of PSA infarction in addition to previously reported mechanisms such as direct obliteration by the embolic materials and extended thrombosis of the VA stump.

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