A Diagnostic Dilemma: Cervical Cord Infarction Caused by Vertebral Artery Dissection and Mimicking a Demyelinating Disease (P03.136)

Abstract

Objective: To report a unique case of an incomplete anterior spinal artery syndrome related to unilateral vertebral artery dissection, causing a partial anterior cervical cord infarction. Background Cervical cord infarction is less common than thoracolumbar cord infarction and accounts for 7-25% of spinal cord infarcts. Vertebral artery dissection is a rare cause of cervical cord infarction, especially in children. Design/Methods: A previously healthy 8-year-old boy developed acute left-sided weakness a few hours after he slipped and landed on his right knee without loss of consciousness or observed head trauma. In retrospect, he had neck pain for 3-4 days prior to the fall. His neurological exam revealed rightward end-gaze nystagmus, deviation of the uvula to the left, left-sided weakness (2-3/5), and decreased sensation to pinprick on the right side of the body without sensory loss to light touch or vibration bilaterally. Results: Magnetic resonance imaging (MRI) of the cervical spine showed an increased T2-weighted signal in the left cervical cord at the level of C3-C4 suggestive of demyelination. Brain MRI showed a symmetric increased T2-weighted signal in the medullary pyramids. Cerebrospinal fluid analysis was normal. He was initially treated with high dose steroids for three days. A follow-up cervical spine MRI revealed a new increased T2-weighted signal in the C4 vertebral body suggestive of ischemia. A computerized tomography (CT) angiogram of the head and neck revealed a non-occlusive dissection of the right intracranial vertebral artery at the level of foramen magnum. The child was started on therapeutic dose of enoxaparin. His weakness improved over a few days and he was ambulatory at the time of discharge. Conclusions: The diagnosis of cervical cord infarction from vertebral artery dissection requires a high level of suspicion, especially in children, and should be considered in the differential diagnosis of partial anterior cervical cord syndrome. Disclosure: Dr. Hannawi has nothing to disclose. Dr. Parnes has nothing to disclose. Dr. Zhorne has nothing to disclose. Dr. Jarjour has nothing to disclose. Dr. Neul has nothing to disclose. Dr. Nassif has nothing to disclose.