Thoracic Spinal Cord Infarction Presenting as Isolated Monoplegia

No abstract available.

Posterior Spinal Artery Infarction Presenting as a Sensory Ataxia

No abstract available.

Paraplegia Following Intercostal Nerve Neurolysis with Alcohol and Thoracic Epidural Injection in Lung Cancer Patient

The goal of cancer treatment is generally pain reduction and function recovery. However, drug therapy does not treat pain adequately in approximately 43% of patients, and the latter may have to undergo a nerve block or neurolysis. In the case reported here, a 42-year-old female patient with lung cancer (adenocarcinoma) developed paraplegia after receiving T8-10 and 11th intercostal nerve neurolysis and T9-10 interlaminar epidural steroid injections. An MRI results revealed extensive swelling of the spinal cord between the T4 spinal cord and conus medullaris, and T5, 7-11, and L1 bone metastasis. Although steroid therapy was administered, the paraplegia did not improve.

Anterior Spinal Artery Infarction Presenting with Hemiparesis

No abstract available.

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.

Cervical Spinal Cord Infarction Presenting Brown-Séquard-plus Syndrome / 계명의대학술지

Brown-Séquard-plus syndrome is characterized by hemiparesis, contralateral spinothalamic sensory deficits with additional abnormal findings of other organs. We report a case of an 81-year-old man who had right hemiparesis, left sensory deficit and Horner syndrome on right eye. Diffusion-weighted MRI of the cervical spine and lower medulla confirm the diagnosis of anterior unilateral cervical spinal cord infarction. It is very rare that the unilateral long spinal cord infarction at the C1-C4 associated with Brown-Séquard-plus syndrome.

Spinal Cord Infarction Caused by Non-dissected and Unruptured Thoracoabdominal Aortic Aneurysm with Intraluminal Thrombus

Spinal cord infarction, especially anterior spinal artery syndrome, is a relatively rare disease. We report a case of spinal cord infarction caused by thoracoabdominal aortic aneurysm with intraluminal thrombus. A 52-year-old man presented with sudden onset paraplegia. At first, he was diagnosed with cervical myelopathy due to a C6-7 herniated intervertebral disc, and had an operation for C6-7 discetomy and anterior interbody fusion. Approximately 1 month after the operation, he was transferred to the department of rehabilitation in our hospital. Thoracoabdominal aortic aneurysm with intraluminal thrombus was found incidentally on an enhanced computed tomography scan, and high signal intensities were detected at the anterior horns of gray matter from the T8 to cauda equina level on T2-weighted magnetic resonance imaging. There was no evidence of aortic rupture, dissection, or complete occlusion of the aorta. We diagnosed his case as a spinal cord infarction caused by thoracoabdominal aortic aneurysm with intraluminal thrombus.

A Case of Postoperative Paraparesis after Ascending Aortic Replacement for Type A Acute Aortic Dissection / 日本心臓血管外科学会雑誌

Although paraplegia following descending thoracic and thoracoabdominal aortic repair is well known, paraplegia after repairing ascending aorta has been rarely reported. We describe a very rare case of postoperative paraparesis after repairing type A acute aortic dissection. A 64-year-old man with type A acute aortic dissection whose aortic false lumen was all thrombosed, was treated with rest and his blood pressure was strictly controlled. The follow-up computed tomography revealed that blood flow in the false lumen was recognized in the ascending aorta 8 days after admission. At the same time the diameter of the ascending aorta was enlarged. We performed emergency ascending aortic replacement under deep-hypothermic circulatory arrest and selective cerebral perfusion. We recognized that he showed paraparesis 4 days after operation and magnetic resonance imaging showed high signals in the spinal cord, which indicated spinal cord infarction. He received rehabilitation for 5 months, and fully recovered neurologically. The causes of paraplegia after repairing type A acute aortic dissection have not been clarified. In our case, we presumed the causes included over 60 min circulatory arrest which invoked low spinal perfusion, the anterior spinal artery was thrombosed by selective cerebral perfusion, some intercostals arteries were occluded by postoperative change of the descending aortic false lumen pressure. This case is very rare, and we had to take all possible precautions.

Brown-Sequard Syndrome Caused by Spinal Cord Infarction: A Case Report and Literature Review

Brown-Sequard syndrome is usually observed in patients with compressive myelopathy due to trauma, cord tumors, and degenerative spinal diseases. Brown-Sequard syndrome resulting from spinal cord infarction is rare. We report the case of a 46-year-old man who presented abruptly with left hemiparesis and diminished pain and temperature sensations on his right side below the C6 dermatome. Cervical spine magnetic resonance imaging revealed abnormally high signal intensity in the left lateral parenchyma of the spinal cord at the level of C4 and C6 on T2 weighted images. After excluding other possible causes, a clinical diagnosis of Brown-Sequard syndrome of probable vascular onset was made, associated with spinal cord infarction. The patient was managed conservatively with intravenous fluids and corticosteroids. However, his condition remained mostly unchanged after six months. Here, we present a rare case of spinal cord infarction causing acute Brown-Sequard syndrome, with a review of the literature.

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.

Extensive Spinal Cord Infarction after Surgical Interruption of Thoracolumbar Dural Arteriovenous Fistula Presenting with Subarachnoid Hemorrhage

Nontraumatic intracranial subarachnoid hemorrhage (SAH) attributable to the thoracolumbar dural arteriovenous fistulas (DAVFs) has been extremely rare. A 41-year-old male patient was admitted with severe acute headache, neck stiffness, and pronounced low-back pain radiating to both legs. The T2-weighted MR imaging showed irregular signal void and enlarged, varix like pouch formation with spinal cord compression at the T11-12 level. The angiogram revealed a DAVF.

Paraplegia due to Spinal Cord Infarction After Lifting Heavy Objects

Spinal cord infarction is uncommon and usually presents with sudden onset of motor and sensory disturbances. We report a case of a 64-year-old women without previous medical history, who presented with acute onset of paraplegia after lifting. However, radiologic examinations did not show any abnormal lesion in the spinal cord. And, cerebrospinal fluid studies also showed no remarkable findings. This case illustrates the cause of spontaneous paraplegia after lifting injury and we consider the presumptive cause of paraplegia as spinal cord infarction.

Spinal Cord Infarction following Spine Surgery in the Patient with Vertebral Bursting Fracture : A case report / 대한마취과학회지

Spinal cord infarction as a complication of spine surgery occurs rarely. Herein, a case of spinal cord infarction, which developed in a 69 year old woman following posterior decompression and internal fixation for a T11 bursting fracture, is descirbed. The anesthetic induction and intraoperative course were uneventful, except at the end of the procedure, where her blood pressure suddenly dropped from 130/90 to 90/60 mmHg. The patient was aggressively treated with a transfusion and vasopressor, the blood pressure then returned to its usual value within 10 minutes. However, during a physical examination in the recovery room, the patient was found to have flaccid lower limbs, with impaired sensory function below the T8 level. Her cord diameter had increased, and a high signal lesion was observed within the thoracic spinal cord, from T9 to T12 level on T2-weighted MR images, which was diagnosing as a spinal cord infarction, was and showed no improvement despite the immediate and aggressive treatment.

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.

Lumbar Sympathetic Block for Spinal Cord Infarction Patient: A case report / 대한통증학회지

This report describes a case of spinal cord infarction after acupuncture. The patient was treated with lumbar sympathetic block with using C-arm fluoroscopy. A 66-year-old patient with chronic low back pain and radiating pain in the lower limb was treated with acupuncture and he suddenly had a loss of motor and sensory of both lower extremities. His clinical presentaion and neuroimaging studies were consistent with spinal cord infarction. He was treated with steroid megatherapy and he showed improved in motor function, but there was no pain relief despite the phamacological treatments that were combined with caudal blockade. He visited to our hospital and had lumbar sympathetic blockade performed. The pain was relieved without any related complication after 1 month (VAS 9/10 --> 2/10), and he has been content with the results of treatment.

Posterior Thoracic Spinal Cord Artery Infarction

No abstract available.

Spinal Cord Infarction with Anterior Chest Pain

We report a man who presented anterior chest pain with mild weakness of both hands while swimming. Initially, he was admitted to the department of internal medicine for evaluation and management of suspected myocardial infarction. Cardiac evaluations including coronary angiogram showed the patient to be normal. Spinal MRI showed a hyperintense signal on the sagittal T2-weighted images at the cervical spinal cord (C6-7). When a patient with chest pain shows weakness in both arms, not only cardiac evaluation but also spine work up is needed.

Two Cases of Spinal Cord Infarction: Vertebral Stenosis and Systemic Hypoperfusion

We experienced two cases of cord infarction. One patient developed quadriparesis and impaired pain and temperature sensation, whose T2-weighted MRI revealed a high-intensity lesion from medulla to C5. Angiography showed severe stenosis of both vertebral arteries. Another patient developed paraplegia and loss of all sensory modalities after cardiac arrest, whose T2-weighted MRI revealed a high-intensity lesion in the cord at T11-L1. We conclude that each cause of the infarctions was stenosis of the vertebral arteries and systemic hypoperfusion.

Diffusion-Weighted MR Imaging of Spinal Cord Infarction

PURPOSE: To evaluate the usefulness of diffusion-weighted imaging(DWI) and quantitative apparent diffusion coefficient (ADC) maps in the patients with spinal cord infarction. MATERIALS AND METHODS: We studied 6 patients presented symptoms with spinal cord infarction, retrospectively(3 men and 3 women). We obtained multi-shot echo planar-based, DWI using 1.5T MR scanner at 5.4 mean days after the onset of ischemic symptoms. In six patients, signal intensity was acquired at conventional b value (1000s/mm2). The ADC value for the normal spinal cord and for infarcted lesions was measured from the trace ADC maps by using regions of interest positioned over the spinal cord. We analyzed signal intensity of lesion on MRI and DWI, and compared with ADC values in infarcted lesions and normal site. RESULTS: T1-weighted MR image showed iso-signal intensity in four of six patients and low signal intensity in two of six. T2-weighted MR image demonstrated high signal intensity in all of six. All DWI were considered to be diagnostic. All of six depicted a bright signal intensity on DWI. ADC values of infarcted lesion were measured lower than that of normal spinal cord on ADC map. The differences in ADC values between infarcted and normal spinal cord were significantly different (p<0.05). CONCLUSION: It is possible to obtain DWI and ADC map of the spinal cord and DWI may be useful in the early diagnosis and localization of lesion site in patients with spinal cord infarction.

Selective Spinal Cord Infarction on Gray Matter in a Child with Injured Unilateral Vertebral Artery: A case report

Several studies report varing incidence of spinal cord injury without radiologic abnormality (SCIWORA) from 21% to 66% in children. Fifty-five percentage of SCIWORA involves the cervical cord. The mechanisms of neural damage of SCIWORA include flexion, hyperextension, longitudinal distraction and ischemia. But spinal cord infarction related to vertebral arterial injury is rare. The authors report a case of selective spinal cord infarction on gray matter with unilateral vertebral artery injury after a minor trauma, in a 4-year-old boy. Neurological signs and symptoms developed 12 hours after the trauma. Initial postcontrast magnetic resonance imaging (MRI) showed an enhancement in the left vertebral artery. Follow up postcontrast MRI showed a selective signal change on the central gray matter and unilateral vertebral artery. We present this case with the review of literatures.