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Atypical Anterior Spinal Artery Infarction due to Left Vertebral Artery Occlusion Presenting with Bilateral Hand Weakness.

Kim MJ, Jang MH, Choi MS, Kang SY, Kim JY, Kwon KH, Kang IW, Cho SJ - J Clin Neurol (2014)

Bottom Line: His motor symptoms improved rapidly except for mild weakness in his left wrist and fingers.Magnetic resonance angiography showed proximal occlusion of the left vertebral artery; a spine MRI revealed left cervical cord infarction.Bilateral or unilateral hand weakness can be the sole symptom of a cervical cord infarct.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Infarct of the anterior spinal artery is the most common subtype of spinal cord infarct, and is characterized by bilateral motor deficits with spinothalamic sensory deficits. We experienced a case with atypical anterior-spinal-artery infarct that presented with bilateral hand weakness but without sensory deficits.

Case report: A 29-year-old man presented with sudden neck pain and bilateral weakness of the hands. Magnetic resonance imaging (MRI) of the brain did not reveal any lesion. His motor symptoms improved rapidly except for mild weakness in his left wrist and fingers. Magnetic resonance angiography showed proximal occlusion of the left vertebral artery; a spine MRI revealed left cervical cord infarction.

Conclusions: Bilateral or unilateral hand weakness can be the sole symptom of a cervical cord infarct.

No MeSH data available.


Related in: MedlinePlus

A: Severe stenosis and occlusion of the proximal part of the left vertebral artery in a neck CT angiogram. B: Axial T2-weighted image showing severe stenosis of the left vertebral artery due to dissection, showing a pseudo lumen with mural thrombi (arrow), and a high signal intensity in the left gray matter of spinal cord at the C4 level.
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Figure 1: A: Severe stenosis and occlusion of the proximal part of the left vertebral artery in a neck CT angiogram. B: Axial T2-weighted image showing severe stenosis of the left vertebral artery due to dissection, showing a pseudo lumen with mural thrombi (arrow), and a high signal intensity in the left gray matter of spinal cord at the C4 level.

Mentions: A healthy 29-year-old man without any vascular risk factors presented with sudden neck pain and bilateral hand weakness. After flexing his neck while tying his shoelaces, the patient experienced a sudden, severe pain (with a maximum score on a visual analog scale) that started in the posterior neck and spread rapidly across the entire head. Bilateral hand weakness that followed the pain onset prevented the patient from tying his shoelaces. The patient's vital signs were stable upon hospital admission, except for markedly elevated blood pressure (202/108 mm Hg). The initial neurological examination revealed weakness in both flexion and extension of the wrists and fingers bilaterally, and during left leg extension [Medical Research Council (MRC) grade 4]. However, the deep tendon reflexes were normal and the patient denied hypoesthesia in any sensory modality including pain, temperature, proprioception, and vibration. A detailed examination did not reveal any cortical sensory sign such as graphesthesia. The Romberg test produced a negative result. Laboratory findings were normal, and chest radiography did not reveal any pathology; an electrocardiogram also produced no evidence of ischemia or arrhythmia. Furthermore, 2-D echo and transesophageal echocardiograms provided no evidence for an embolic stroke. Subsequent 24-hour Holter monitoring failed to identify any arrhythmia or atrial fibrillation. His motor symptoms improved rapidly within 1 day except for mild weakness of his left wrist (MRC grade of flexion/extension IV/IV) and fingers (MRC grade of flexion/extension IV/IV; slightly more severe in the 5th finger). Brain computed tomography (CT) and brain magnetic resonance imaging (MRI) did not reveal any signal abnormalities or mass lesions. However, CT aortography identified severe stenosis and occlusion of the left vertebral artery, and a pseudo lumen with mural thrombi was suspected on cervical MRI (Fig. 1). These clinical and radiological findings implicated arterial dissection. MRI of the cervical segment produced high signal intensities in the left gray matter of spinal cord at the C3, C4, and C6 levels on diffusion-weighted images (Fig. 2). The patient was discharged on an oral anticoagulant. Magnetic resonance angiography performed 3 months after symptom onset showed persistent occlusion of the left vertebral artery.


Atypical Anterior Spinal Artery Infarction due to Left Vertebral Artery Occlusion Presenting with Bilateral Hand Weakness.

Kim MJ, Jang MH, Choi MS, Kang SY, Kim JY, Kwon KH, Kang IW, Cho SJ - J Clin Neurol (2014)

A: Severe stenosis and occlusion of the proximal part of the left vertebral artery in a neck CT angiogram. B: Axial T2-weighted image showing severe stenosis of the left vertebral artery due to dissection, showing a pseudo lumen with mural thrombi (arrow), and a high signal intensity in the left gray matter of spinal cord at the C4 level.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4017022&req=5

Figure 1: A: Severe stenosis and occlusion of the proximal part of the left vertebral artery in a neck CT angiogram. B: Axial T2-weighted image showing severe stenosis of the left vertebral artery due to dissection, showing a pseudo lumen with mural thrombi (arrow), and a high signal intensity in the left gray matter of spinal cord at the C4 level.
Mentions: A healthy 29-year-old man without any vascular risk factors presented with sudden neck pain and bilateral hand weakness. After flexing his neck while tying his shoelaces, the patient experienced a sudden, severe pain (with a maximum score on a visual analog scale) that started in the posterior neck and spread rapidly across the entire head. Bilateral hand weakness that followed the pain onset prevented the patient from tying his shoelaces. The patient's vital signs were stable upon hospital admission, except for markedly elevated blood pressure (202/108 mm Hg). The initial neurological examination revealed weakness in both flexion and extension of the wrists and fingers bilaterally, and during left leg extension [Medical Research Council (MRC) grade 4]. However, the deep tendon reflexes were normal and the patient denied hypoesthesia in any sensory modality including pain, temperature, proprioception, and vibration. A detailed examination did not reveal any cortical sensory sign such as graphesthesia. The Romberg test produced a negative result. Laboratory findings were normal, and chest radiography did not reveal any pathology; an electrocardiogram also produced no evidence of ischemia or arrhythmia. Furthermore, 2-D echo and transesophageal echocardiograms provided no evidence for an embolic stroke. Subsequent 24-hour Holter monitoring failed to identify any arrhythmia or atrial fibrillation. His motor symptoms improved rapidly within 1 day except for mild weakness of his left wrist (MRC grade of flexion/extension IV/IV) and fingers (MRC grade of flexion/extension IV/IV; slightly more severe in the 5th finger). Brain computed tomography (CT) and brain magnetic resonance imaging (MRI) did not reveal any signal abnormalities or mass lesions. However, CT aortography identified severe stenosis and occlusion of the left vertebral artery, and a pseudo lumen with mural thrombi was suspected on cervical MRI (Fig. 1). These clinical and radiological findings implicated arterial dissection. MRI of the cervical segment produced high signal intensities in the left gray matter of spinal cord at the C3, C4, and C6 levels on diffusion-weighted images (Fig. 2). The patient was discharged on an oral anticoagulant. Magnetic resonance angiography performed 3 months after symptom onset showed persistent occlusion of the left vertebral artery.

Bottom Line: His motor symptoms improved rapidly except for mild weakness in his left wrist and fingers.Magnetic resonance angiography showed proximal occlusion of the left vertebral artery; a spine MRI revealed left cervical cord infarction.Bilateral or unilateral hand weakness can be the sole symptom of a cervical cord infarct.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Infarct of the anterior spinal artery is the most common subtype of spinal cord infarct, and is characterized by bilateral motor deficits with spinothalamic sensory deficits. We experienced a case with atypical anterior-spinal-artery infarct that presented with bilateral hand weakness but without sensory deficits.

Case report: A 29-year-old man presented with sudden neck pain and bilateral weakness of the hands. Magnetic resonance imaging (MRI) of the brain did not reveal any lesion. His motor symptoms improved rapidly except for mild weakness in his left wrist and fingers. Magnetic resonance angiography showed proximal occlusion of the left vertebral artery; a spine MRI revealed left cervical cord infarction.

Conclusions: Bilateral or unilateral hand weakness can be the sole symptom of a cervical cord infarct.

No MeSH data available.


Related in: MedlinePlus