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Case Reports
. 2014 Mar;37(2):233-6.
doi: 10.1179/2045772313Y.0000000125. Epub 2013 Nov 26.

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

Sébastien Richard, Chifaou Abdallah, Anne Chanson, Sylvain Foscolo, Pierre-Alexandre Baillot, Xavier Ducrocq
Case Reports

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

Sébastien Richard et al. J Spinal Cord Med. 2014 Mar.

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.

Keywords: Cervical arterial dissection; Cervical spinal cord infarction; Posterior spinal cord; Vertebral artery.

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Figures

Figure 1
Figure 1
Computed tomography angiograghy (A) and conventional angiography (B) showing a false aneurysm of the right carotid artery. Conventional angiography (C) showing occlusion of the right vertebral artery and a false aneurysm of the left one. This aspect was compatible with dissection of both vertebral and the right carotid arteries.
Figure 2
Figure 2
Magnetic resonance imaging of cervical spinal cord with sagittal T2-weighted images (A), axial T2-weighted images (B) and diffusion weighted images (C) showing hyperintensity in the right posterior cord at level C1. This aspect was compatible with unilateral right posterior cervical spinal cord infarction.
See this image and copyright information in PMC

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