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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

Approximate locations of the motor neurons in the anterior gray horn of the cervical cord.
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Figure 3: Approximate locations of the motor neurons in the anterior gray horn of the cervical cord.

Mentions: The anterior spinal artery forms at the level of the foramen magnum from the branches of the vertebral artery, and gives rise to the sulcal (central) arteries that penetrate the right and left sides of the spinal cord.3 Unlike circumferential areas of the spinal cord, its interior has no anastomosis and the sulcal arteries are essentially end arteries. Therefore, the weakness of both hands in the present patient suggests that the end-arteries zone or the zone bordering the sulcal artery and circumferential artery corresponds to a region where hand motor neurons are located bilaterally.8 This would include the ventrolateral to lateral regions within the gray matter of the lower cervical spinal cord (Fig. 3).9,10 Alternatively, the hand motor areas may be more vulnerable than the more proximal arm motor areas. The hand motor area occupies a relatively large proportion of the cortical homunculus, so the hand motor area may occupy a larger area in the spinal gray matter, or require a larger blood supply.11,12


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)

Approximate locations of the motor neurons in the anterior gray horn of the cervical cord.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Approximate locations of the motor neurons in the anterior gray horn of the cervical cord.
Mentions: The anterior spinal artery forms at the level of the foramen magnum from the branches of the vertebral artery, and gives rise to the sulcal (central) arteries that penetrate the right and left sides of the spinal cord.3 Unlike circumferential areas of the spinal cord, its interior has no anastomosis and the sulcal arteries are essentially end arteries. Therefore, the weakness of both hands in the present patient suggests that the end-arteries zone or the zone bordering the sulcal artery and circumferential artery corresponds to a region where hand motor neurons are located bilaterally.8 This would include the ventrolateral to lateral regions within the gray matter of the lower cervical spinal cord (Fig. 3).9,10 Alternatively, the hand motor areas may be more vulnerable than the more proximal arm motor areas. The hand motor area occupies a relatively large proportion of the cortical homunculus, so the hand motor area may occupy a larger area in the spinal gray matter, or require a larger blood supply.11,12

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