A case of cerebellar and spinal cord infarction presenting with acute brachial diplegia due to right vertebral artery occlusion

• Published in: Rinsho Shinkeigaku Vol. 52; no. 6; pp. 425 - 428
• Main Authors: Fujii, Takayuki, Santa, Yo, Akutagawa, Noriko, Nagano, Sukehisa, Yoshimura, Takeo
• Format: Journal Article
• Language: Japanese
• Published: Japan Societas Neurologica Japonica 2012
• Subjects: Acute Disease; Aged; anterior spinal artery syndrome; Arterial Occlusive Diseases - complications; Arterial Occlusive Diseases - diagnosis; Brain Infarction - diagnosis; Brain Infarction - etiology; Cerebellum; cervical infarction; cervical spondylosis; Cervical Vertebrae; Chronic Disease; Humans; Infarction - diagnosis; Infarction - etiology; Magnetic Resonance Imaging; Male; Paresis - etiology; Spinal Cord - blood supply; Spinal Cord Compression - complications; Spinal Cord Compression - diagnosis; unilateral vertebral artery occlusion; Vertebral Artery
• ISSN: 0009-918X; 1882-0654
• DOI: 10.5692/clinicalneurol.52.425

A 73-year-old man was admitted for evaluation of sudden onset of dizziness, bilateral shoulder pain, and brachial diplegia. Neurological examination revealed severe bilateral weakness of the triceps brachii, wrist flexor, and wrist extensor muscles. There was no paresis of the lower limbs. His gait was ataxic. Pinprick and temperature sensations were diminished at the bilateral C6-C8 dermatomes. Vibration and position senses were intact. An MRI of the head revealed a right cerebellar infarction and occlusion of the right vertebral artery. An MRI of the cervical spine on T2 weighted imaging (T2WI) showed cord compression at the C3/4-C5/6 level secondary to spondylotic degeneration without any intramedullary signal changes of the cord. On the following day, however, high-signal lesions on T2WI appeared in the C5-C6 spinal cord, suggesting cord infarction. Unilateral vertebral artery occlusion does not usually result in cervical cord infarction because of anastomosis of arteries. Because of the long-term mechanical compression in our case, it was likely that cervical cord ischemia was present before the onset of symptoms. On the basis of chronic cord compression, our case suggests that occlusion of a unilateral vertebral artery could cause cervical cord infarction.