Thoracic Spinal Cord Infarction Presenting as Isolated Monoplegia

No abstract available.

Application of Gemstone Spectrum Imaging for anterior spinal artery in patients with cervical spinal injury / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the value of Gemstone Spectrum Imaging (GSI) CT anterior spinal artery angiography in the patients with cervical spinal cord injury, and to evaluate the correlation between the change of the blood flow of the anterior spinal artery and the postoperative recovery of nerve function.</p><p><b>METHODS</b>From January 2014 to June 2016, thirty patients who underwent cervical open door laminoplasty for spinal cord injury were retrospective analyzed and included 21 males and 9 females with an average age of (46.4±9.7) years old ranging from 33 to 59 years. Within 2 weeks after injury, open door laminoplasty was performed through cervical posterior approach. Among them, there were 8 cases of 3 segments of open door decompression, 18 cases of 4 segments, 4 cases of 5 segments. GSI CT were performed at 3 days before operation and 5 days after operation. The anterior spinal artery was reconstructed and evaluated the improvement of blood flow after operation. The cervical JOA score was calculated at 1 day before operation, 5 days after operation and 1, 6 and 12 months after operation, and the JOA score improvement rate of the corresponding follow-up points was calculated.</p><p><b>RESULTS</b>All patients were followed up for 12 to 30 months with an average of (17.4±7.6) months. The iodine content ratio (ASA/VA) of the anterior spinal artery before and after operation was 0.75±0.20 and 0.89±0.02 respectively, the postoperative improvement was significantly higher than that before operation(<0.01). The average ASA/VA improvement rate was(21.05±12.45)% after operation. There was a positive linear correlation between the improvement of blood flow and the improvement of JOA score at 1, 6 and 12 months after operation.</p><p><b>CONCLUSIONS</b>GSI CT anterior spinal artery angiography is safe and feasible, the imaging is satisfactory, it can quantitatively evaluated the blood flow of the anterior spinal artery. There was a positive linear correlation between the improvement of blood flow in anterior spinal artery and the recovery of neurological function. Early postoperative improvement of blood flow in the anterior spinal artery can be used as a reference index for predicting the recovery of neurological function in patients.</p>

Pulmonary embolism complicated with abnormal spinal cord embolism due to lack of protein S activity: a case report / 中华神经科杂志

Spinal vascular disease is rare in clinic, especially in cases of spinal cord embolism caused by abnormal embolism. It is rare in clinic and has not been reported in China. We report a case of pulmonary embolism complicated with abnormal spinal cord embolism due to lack of protein S activity and analyze its clinical data in order to improve clinical understanding of the disease.

Anterior spinal artery syndrome following coronary artery bypass grafting: a case report

Abstract We present a patient with unstable angina candidate for coronary artery bypass grafting. Saphenous vein graft was used in obtuse marginal and left internal mammary artery to left anterior descending artery properly. After surgery, the patient experienced flaccid paralysis of lower limb and impaired sensation of touch and warmth of knee and below. A computed tomography angiogram of lower limbs and thoracolumbar magnetic resonance imaging showed no abnormality. Based on the symptom, clinical diagnosis of anterior spinal artery syndrome was considered. The artery of Adamkiewicz is an important supplier to the anterior spinal artery. Internal thoracic mammary artery, used in coronary artery bypass grafting, is suspected as a collateral supplier of the artery of Adamkiewicz and has been accused for cause of spinal infarction.

Anterior Spinal Artery Infarction Presenting with Hemiparesis

No abstract available.

Anesthetic Management in an Established Case of Anterior Spinal Artery Syndrome Posted for Inguinal Hernioplsty.

Anterior spinal artery syndrome (ASAS) is a rare and permanent damage, caused as a neurological complication of spinal anesthesia. In this case study, we have given account of our experience of anesthetic management of a documented case of ASAS, posted for inguinal hernioplasty. We did a thorough pre-anesthetic evaluation and found that patient had paraplegia and confi ned to bed with aspiration pneumonitis. He is a known hypertensive and on control with tablet amlodipine 5 mg/day. He was subjected to antibiotic therapy, mucolytics with respiratory physiotherapy and incentive spirometry. After preparing the patient thoroughly, patient was subjected to general anesthesia. Post-operative analgesia was provided with injection fentanyl, given with a syringe pump. Post-operative period was uneventful.

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

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.

Importance of Selective Cerebral Perfusion (SCP) to Prevent Intraoperative Ischemic Spinal Cord Injury in Surgical Case of Acute Type A Aortic Dissection / 日本心臓血管外科学会雑誌

We report a rare case of surgical treatment for acute type A aortic dissection with expansion of the false lumen. The patient was a 72-year-old man without any motor paresis who underwent total aortic arch replacement with two-vessel perfusion of SCP and mild hypothermic circulatory arrest for the lower half of the body. Postoperatively, the patient had tetraparesis which was more severe than in his lower extremities, whereas the sensory function was preserved. It was assumed that the anterior horns of the spinal cord were injured longitudinally due to insufficient blood flow of the anterior spinal artery through the SCP. This case suggests that three-vessel perfusion of SCP is important in surgical treatment for acute type A aortic dissection for the prevention of intraoperative ischemic spinal cord injury.

A Ruptured Aneurysm in the Branch of the Anterior Spinal Artery

Incidence of aneurysm of the anterior spinal artery is known to be very low and the standard treatment strategy has not yet been established. The author experienced a case of subarachnoid hemorrhage (SAH) caused by the rupture of an aneurysm in the branch of the cervical anterior spinal artery, which was managed conservatively. The patient had end-stage common bile duct cancer and survived for 103 days after onset of the SAH without a re-rupture of the aneurysm.

Antiphospholipid Syndrome Presented With Anterior Spinal Artery Syndrome

Antibodies to cardiolipin and other phospholipid have been associated with recurrent thrombotic events, including ischemic strokes, especially in children and young adults. Recently it has been shown that anti-beta2-glycoprotein I antibodies may be more specific in predicting thrombosis. We report a case of anterior spinal artery syndrome with elevated titer of antibodies to beta2-glycoprotein I in young adult.

Pure Motor Function Loss of Bilateral Upper Extremities after Anterior Spinal Cord Infarction: A case report

Anterior spinal artery syndrome refers to the paralysis of the bilateral upper extremities, bladder dysfunction and the sensory deficit of pain and temperature below the level of injury. A 64 year-old female got a cardiac arrest event after stent insertion into the coronary artery. After CPR, she underwent the motor deficit (Z-T) of the bilateral upper extremities without any sensory deficit; proprioception, vibration and pain. The brain MRI showed no abnormality, but high signal intensity was detected in C3-C7 level by T2 sagittal plane and at the anterior horn area of gray matter by axial view of spine MRI. The ventilator has been applied after CPR. By the fluoroscopy, the movement of the diaphragm was decreased, and the nerve conduction study of both phrenic nerves showed no responses.

Transient quadriplegia after fluoroscopic-guided selective cervical nerve root block in a patient who received cervical interbody fusion: A case report / 대한마취과학회지

Selective cervical nerve root block is executed for patients who have symptoms of cervical radiculopathy for diagnostic and therapeutic purposes. However several catastrophic complications caused by this procedure have been reported including neurological complications. A 43-year-old male received a C5 selective cervical nerve root block procedure due to continuous radiating pain even after cervical discectomy and interbody fusion was performed. At the time of the procedure, the contrast outline revealed reflux of the nerve root and epidural space. But after the procedure was performed, the patient experienced decreased sensation in the upper and low extremities as well as motor paralysis of both extremities. Our sspecting diagnosis was anterior spinal artery syndrome but both sensory and motor functions were subsequently recovered within a few hours after the procedure was completed. Due to the difficult nature of this case, we reported these complications and reviewed current literature related to this study.

Diagnosis and treatments for anterior spinal artery syndrome induced by cervical disc herniation / 中国矫形外科杂志

[Objective]To discuss the diagnosis,treatments and the outcome of anterior spinal artery syndrome induced by cervical disc herniation.[Methods]Eighteen patients(male 13,female 5,average age 35.6 years old) were diagnozed to experience cervical disc herniation by MRI scans.All the patients presented with severe motor paralysis with loss of sensation to pain and temperature but sparing of proprioceptive sensation,which was just like the clinical features of anterior spinal artery syndrome.The average preoperative JOA score was 7.6 points,ranged from 4 to 10.Anterior cervical decompression with fusion was performed on 17 patients within 15 days.Spinal canal occupation was found in 1 case.Posterior approach treatment was not effective and anterior approach decompression was performed 1 year later.[Results]All these patients were followed up for an average of 15 months(12 to 24 months).Seventeen patients had a good outcome.The postoperative JOA score ranged from 7 to 15 points(13.4 in average) and the mean JOA recovery ratio was 61.7%.All the patients recovered with no complication.[Conclusion]A herniated cervical disc can compress the spinal anterior artery and involve with anterior spinal artery syndrome.It can be final diagnozed with clinical features and MRI scans.The outcome is satisfactory when an early and complete anterior decompression with fusion is performed.

Anterior Spinal Artery Syndrome Associated With Cervical Spinal Stenosis

BACKGROUND: The anterior spinal artery infarction constitutes a classical syndrome of vascular myelopathy. The causes of the anterior spinal artery syndrome are various, but most episode probably occur as the result of atherosclerosis or dissection of the aorta and its branches. However, few cases reported developed with spinal structural abnormalities. CASE: A 65-year-old man presented with sudden paraparesis. There was no evidence of hypertension, diabetes and smoking. Motor weakness was more prominent on the left side and progressed. Loss of pain and temperature senses were shown at the level of 71 with preservation of touch, joint perception and vibration senses. The DTR's of legs were depressed and extensor toe signs were presented. A C-spine MRI showed high signal intensity on 72 weighted image and low signal on 71 weighted image(C6-71) with cervical spinal stenosis at the C4-C7 spinal level and mild cervical disc protrusion (C6-C7, C7-T1). After three months later, follow up cervical MRI showed somewhat decreased size of high signal intensity on 72 weighted image and more prominent low signal on 71 image. DISCUSSION: In our case, we could not find any usual cause of anterior spinal artery infarction. However only cervical spinal stenosis associated with mild cervical disc protrusion was present. In stenotic cervical canal, the anterior spinal artery can be more vulnerable to extrinsic compression and the infarction may early develop with insignificant trigger event, such as disc protrusion. We concluded that the ischemic change of anterior two thirds of cervical spinal cord might develop due to the compression of the anterior spinal artery by cervical stenosis and mild cervical intervertebral disc protrusion.