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Posterior Unilateral Spinal Cord Infarction Caused by Vertebral Artery Dissection
First author：Jiang Qianmei
Corresponding author：Tian Decai,Jing Jing
essential_information
- Person in charge：Jiang Qianmei
- Data Sources： OTHERS
- Number of papers：OTHERS20230130
- Published time：2023-08-21
2023-08-21
Published articles
Journal：Annals of Neurology
Publication type: Case Report
IF(IF): 11.2
PMID: 37605322 Link To Pubmed Full text Download
Background And Purpose
Spontaneous spinal cord infarction (SCI) is a rare disorder with severe deficits, accounting for about 1% of all strokes1. The most probable mechanism of spontaneous SCI is idiopathic atherosclerosis (68%), while vertebral artery dissection accounts for only 3%2. For the richer blood supply comprising two posterior spinal arteries and a more extensive collateral network, spontaneous vertebral artery dissection seldom affects the spinal cord, and even if it does, it always involves the anterior spinal artery1 . Here, we reported a patient with long-segment posterior spinal cord infarction caused by vertebral artery dissection.
Method
In April 2023, a 24-year-old man was hospitalized complaining of sudden persistent numbness and weakness of the left limbs 4 days ago, with neck pain and urinary dysfunction. Symptoms worsened 1 day later, rendering him unable to walk, and numbness and paralysis were extended to his right limbs. The detailed patient interview found no history of trauma or family medical conditions, except for a previously chickenpox 6 months ago. Neurological examination revealed decreased tactile sensation in the left side of the face and right side of the limbs, as well as diminished vibration sensation in the left limbs. The muscle strength of the left limb was rated as 3, while the right limb was rated as 4 out of 5 with bilateral positive Babinski sign.
Conclusion
Dissection of the vertebral artery seldom affects the spinal cord, and involvement of the posterior spinal artery is even less common. This case report provides several unique clinical insights. First, vertebral artery dissection should be considered in cases of posterior spinal cord infarction in the absence of a clear etiology. Second, the intra- and extracranial 3D-vwMRI demonstrates a notable sensitivity to intramural hematoma and outperforms CTA or MRA especially in distinguishing vertebral artery dissection from dysplasia3. This superiority is particularly evident when the characteristic intimal flap and double lumen sign are not detected on other vascular images4. Early diagnosis and identification of the causes of SCI are crucial, especially in young individuals who need urgent rehabilitation. This case suggests a better understanding of spontaneous SCI and may help early and noninvasive identification of the causes of SCI.
Main results
Spine MRI (3.0T) showed the hyperintense lesions at the cord level of C1-C5, affecting the left posterior and posterolateral columns, and even the area around spinal central canal (Fig. A). Despite the smaller diameter of the left vertebral artery (similar as vertebral artery dysplasia) compared to the right side, there was no evidence of stenosis in the left vertebral artery on MRA (Fig. B, yellow arrow). However, three-dimensio na l joint intra-and extracranial vessel wall MRI (3D-vwMRI) revealed a typical feature of a long segment dissection at the V3 segment of left vertebral artery with a mural hematoma and the residual lumen (Fig. C). The patient received oral aspirin at a daily dose of 100 mg and atorvastatin at a daily dose of 40 mg. Subsequently, he was discharged after a 7-day hospitalization period.