Sulcal Artery Syndrome: Report of Two Cases (P03.012)

Abstract

Objective: To present two cases of sulcal artery syndrome. Background Sulcal (also known as central and sulcocommisural) arteries are perforating branches of the anterior spinal artery, which perfuse the anterior 2/3 of a hemicord. Sulcal arteries alternatively perforate the right or left side of the spinal cord at successive levels. Unilateral spinal cord infarction restricted to the perfusion territory of sulcal artery is very rare. All of the four previously reported cases have been associated with vertebral dissection. Design/Methods: Case 1: A 16 year old boy experienced sudden onset of a shooting pain on the right neck and arm after throwing a basketball. Over the next few hours, he developed right arm and leg paralysis. Examination showed right sided hemiplegia and impaired pain and temperature sensation on the left side. Vibratory sensation and proprioception were normal. Case 2: A 41 year old man presented with sudden onset of vertigo, pain on his left shoulder radiating to the nape of the neck and back of the head. Examination showed left upper and lower limb weakness, and impaired pain and temperature sensation on the right side. Results: Case 1: Cervical spinal MRI showed T2 WI signal intensity abnormality extending from C3 to C4 with mild cord expansion. Axial diffusion weighted image showed restricted diffusion in the right hemicord. CT angiogram showed hypoplastic right vertebral artery but no definitive dissection. Case 2: MRI showed acute infarct in the left cerebellum and in the left hemicord from C3-C5. CT angiogram demonstrated a left vertebral artery dissection. Conclusions: Sulcal artery syndrome is to be considered in acute onset of hemiplegia and contralateral pain and temperature impairment. Both of our cases had neck and upper limb pain, which is very uncommon with hemispheric or brainstem strokes. Disclosure: Dr. Da Silva has nothing to disclose. Dr. Brorson has received personal compensation for activities with CVS Caremark Corporation as a consultant. Dr. Rezania has nothing to disclose.