Conus Medullaris Syndrome Due to Posterior Spinal Artery Infarction

A 77-year-old female with a history of osteoarthritis visited our clinic complaining of lower back pain, paresthesia in both legs, and voiding difficulty. Her pain and temperature sensations were diminished below the L1 dermatome, and proprioception was decreased in both feet. The findings of a routine laboratory workup, echocardiogram, and cerebrospinal fluid studies were normal. Spine magnetic resonance imaging revealed high T2-weighted signal intensities and diffusion restriction in the posterior conus medullaris. The patient was diagnosed and treated for posterior spinal artery infarction.

Posterior Spinal Artery Infarction Presenting as a Sensory Ataxia

No abstract available.

Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis

Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature.

Tratamiento quirúrgico de aneurisma de la arteria espinal posterior roto: reporte de un caso y revisión de la literatura / Surgical treatment of ruptured posterior spinal arteryaneurysm. case report and literature review

Los aneurismas de la arteria espinal posterior (AEP) se presentan en su gran mayoría asociados a patologías que generan aumento del flujo arterial como malformaciones o fístula arteriovenosas y también asociadas a enfermedades del colágeno. Su presentación aislada es rara, con 11 casos publicados en la literatura a nuestro conocimiento. Presentamos una paciente de 56 años de edad, usuaria de anticoagulantes orales por accidente cerebro vascular antiguo no secuelado secundario a fibrilación auricular, que se presenta con dolor lumbar súbito no irradiado, al que luego se agrega paraplejia fláccida. En resonancia nuclear magnética se observa hemorragia subaracnoidea espinal con importante compresión medular secundaria. Estudio con angiografía demostró aneursima de aspecto disecante en arteria espinal posterior. Debido a pequeño calibre de arteria nutricia se optó por tratamiento quirúrgico. Angiografia de control mostró exclusión completa de aneurisma. En los controles posteriores la paciente ha mostrado recuperación progresiva del déficit neurológico. Tanto el tratamiento endovascular como el quirúrgico se han reportado para la exclusión de aneurismas de la AEP. El presente caso muestra que el tratamiento quirúrgico precoz es una alternativa sobre todo si además se requiere realizar descompresión medular.

Aneurysms of the Posterior spinal artery (PSA) usually present secondary to high-flow pathologies such as arteriovenous malformations or dural arteriovenous fistulas, also can be associated whit collagen diseases. Isolate PSA aneurysms are rare, whit 11 cases reported, to our knowledge. We present a 56 years old patient, user of oral anticoagulant for an old isquemic stroke, secondary to atrial fibrillation, who presented whit subit lumbar pain and flaccid paraplejia. The magnetic resonance image shows an extensive spinal subarachnoid hemorrhage and secondary medular compression. Spinal angiography study demonstrated a dissecting aneurysm of PSA. Due to the small size of the artery, on which the aneurysm was located, surgical treatment was performed. Follow up angiography shows complete exclusion of the lesion. The patient has had a progressive recovery on her deficit. Both surgical and endovascular treatment have been reported. The present case shows that early surgical treatment is an option, especially if medular decompression is needed.

Ipsilateral Posterior Spinal Artery Infarction on Lower Medulla and Upper Cervical Spinal Cord: A case report

Spinal cord infarction is uncommon and accounts for only 1% of all strokes in comparison with cerebral infarction. Furthermore, posterior spinal cord infarction is particularly rare because of an anastomotic network of direct penetrating vessels and plexus of pial vessels fed by the paired posterior spinal arteries. We report a case of unilateral posterior spinal artery infarction on lower medulla and upper cervical spinal cord in a patient of 60-year-old woman. She complained of continuous headache for several weeks and suddenly presented right facial paresthesia, slow progression of motor weakness and proprioceptive sensory loss on right extremity, and voiding difficulty. Magnetic resonance and computed tomography imaging studies confirmed acute infarction at the right posterolateral aspect of the lower medulla and upper cervical cord (C1-2 level) with right vertebral artery hypoplasia. Transcranial doppler sonography also showed right vertebral artery hypoplasia rather than stenosis with atherosclerosis.

Posterior Thoracic Spinal Cord Artery Infarction

No abstract available.