Posterior Spinal Artery Research Articles

Opalski’s syndrome: A rare variant of lateral medullary syndrome

Opalski’s syndrome: A rare variant of lateral medullary syndrome

Spectrum of clinicoradiological findings in spinal cord infarction: Report of three cases and review of the literature

Spinal cord infarction (SCI) often remains undiagnosed due to infrequent occurrence and lack of established diagnostic procedures. The unique pattern of blood supply explains the heterogeneity of clinical presentation. We present three cases of SCI to highlight the varied spectrum of clinicoradiological findings. The first patient had posterior spinal artery infarction, and spine imaging showed infarction of adjacent vertebral body, which is usually rare. The second patient had anterior spinal artery infarction and the cANCA titers were elevated. The third patient had a pure motor quadriparesis. Initial imaging did not show any cord infarction, but signal changes were noted on serial imaging. Fibrocartilagenous embolism (FCE) seems the most likely etiology in the first and third cases. A high index of clinical suspicion is necessary for prompt diagnosis. Sensitivity of the initial magnetic resonance imaging remains limited, necessitating serial follow-up scans. Infarction of the adjacent vertebral body is a useful confirmatory sign. Fat suppression images can delineate the marrow signal changes better. Elderly patients with vascular risk factors and degenerative discs need to avoid mechanical triggers that predispose to FCE. Younger patients with SCI will need evaluation for cardioembolic source and vasculitis.

Poster 526 Posterior Spinal Artery Syndrome Post Suction Dilation and Curettage With Spinal Anesthesia: A Case Report

Poster 526 Posterior Spinal Artery Syndrome Post Suction Dilation and Curettage With Spinal Anesthesia: A Case Report

Endovascular obliteration of a ruptured posterior spinal artery pseudoaneurysm

Aneurysms of the posterior spinal artery (PSA) are rare lesions. Isolated PSA aneurysms, not in the setting of a high-flow environment, are even more rare. In the few reported cases, these lesions have been predominantly resected or observed. The authors report an isolated pseudoaneurysm of the PSA at the T-11 level presenting with subarachnoid hemorrhage. The patient underwent successful endovascular obliteration. To the authors' knowledge, this is the first report of an endovascular repair of an isolated PSA aneurysm.

Arterial arrangement of the cervical spinal cord in rabbit

The aim of this study was to describe the arterial arrangement of the cervical spinal cord in rabbit because it has been used widely to examine the pathophysiology of spinal cord injury. The study was carried out on 20 adult New Zealand White rabbits. We prepared corrosion casts of the arterial system of the cervical spinal cord. Batson's corrosion casting kit no. 17 was used as a casting medium. The origin of the ventral spinal artery from the right vertebral artery was found on average in 40 % of cases. The origin from the left vertebral artery was found on average in 35 % of cases. The ventral spinal artery raised from the anastomosis of two ventral spinal arteries on average in 25 % of cases. The presence of spinal arteries entering the ventral spinal artery in the cervical region was observed in 46.2 % of cases on the right side and in 53.8 % of cases on the left side. On the dorsal surface we found two irregular dorsal spinal arteries receiving dorsal branches of spinal arteries or they were absent. Until the cervical spinal cord arterial arrangement in species of laboratory animals is described in detail, it will be very difficult to determine the appropriate species for experiments in this field. Variations in arterial arrangement can produce biased or erroneous results in studies.

Dissecting Aneurysm of the Posterior Spinal Artery

Because of their rarity, the pathogenesis and clinical features of isolated spinal artery aneurysms are still unclear, and their diagnoses and treatments are challenging. We report a case of an isolated posterior spinal artery aneurysm and review previous reports thoroughly to identify the general features of isolated spinal aneurysms. A 52-year-old man presented with abdominal pain followed by back pain and radiculopathy from subarachnoid hemorrhage in the spinal canal. The spinal angiogram demonstrated the presence of a dissecting aneurysm of the posterior spinal artery. He was treated by endovascular occlusion of the origin of the radiculopial artery and recovered completely. Isolated spinal artery aneurysms are very rare lesions; however, they should be considered in patients with intracranial or spinal subarachnoid hemorrhage without evidence of arteriovenous malformations. Spinal aneurysms have different etiologies compared with intracranial aneurysms. Cervical aneurysms have worse outcomes than thoracolumbar aneurysms. The etiology and location of the lesion and distal flow to the lesion should be taken into consideration when planning the treatment.

Atypical MRI Findings in a Spinal Dural Arteriovenous Fistula - Histology as Clue to the Diagnosis (P05.258)

Objective: Atypical presentations of spinal dural arteriovenous fistulas (SDAVF) represent a rare condition. Background In differential diagnostic reflections one should keep in mind atypical SDAVF as a significant cause of myelopathy. Design/Methods: We present an elucidating case of atypical diagnostic features in SDAVF. Results: A 60-year-old man developes a fluctuating spinal syndrome over a 3.5-year period. He presents with undulating spastic paraparesis, paresthesias in both legs, disturbances of micturition and defecation, sexual dysfunction and gait difficulties. Spinal MRI demonstrates a slightly contrast enhancing intramedullary lesion with an extension from D6 through D10. Due to the fluctuating clinical course, a SDAVF is considered, but the MRI shows no dilated veins or conus involvement. Cerebrospinal fluid findings are normal. With a differential diagnosis of either myelitis or spinal astrocytoma, treatment with corticosteroids and plasmapheresis is started without any effect. A spinal biopsy reveals no evidence of a tumor, but abnormal fibrotic blood vessels are seen. Therefore a spinal angiography is performed, which shows a SDAVF starting from the segmental thoracic medullary artery at D6 level and slowly draining into a not dilated vein, ranging over 5 vertebrae with no efflux out of the spinal canal. Since embolization seems too dangerous because of the connection between the involved segmental medullary artery and a posterior spinal artery, the fistula is disconnected surgically. During the operation, an atypical course of the vessels on the rather left side of the spinal cord is seen, explaining the atypical MR-findings. Postoperative MRI shows regression of medullary hyperintensity. Conclusions: In this case, the atypical findings in MRI without dilated veins or conus involvement lead to the misdiagnosis of a tumor. Only after the results of a spinal biopsy demonstrating pathological blood vessels spinal angiography is performed. With clinical symptoms of a SDAVF, a spinal angiography is justified even in MRI-negative presentations. Disclosure: Dr. Becker has nothing to disclose. Dr. Kraemer has nothing to disclose. Dr. Stracke has received personal compensation for activities with EV 3 as a consultant. Dr. Keyvani has nothing to disclose. Dr. Berlit has nothing to disclose.

Aneurysm of the lateral spinal artery: A case report

The lateral spinal artery (LSA) constitutes one of the longitudial pathways that connect the extradural and intradural vascular upply. The LSA arises from the intradural vertebral artery (VA) at he C1 level, courses caudally, and descends laterally, parallel to the pinal component of the 11th nerve between the dentate ligament nd the posterior spinal nerve roots [1]. The ascending rami of the SA establish small connections with the posterior inferior cerebelar artery (PICA), whereas the descending rami feed the posterior adicular branches (particularly C-2) (Fig. 1) [1,2]. Posteriorly, there s a connection to the contralateral system via rich pial anastomois. The posterior medullary superficial arteries are branches of the osterior spinal artery or the LSA in the lower medulla oblongata, hereas these vessels arise from the PICA in the upper medulla blongata [3]. The LSA anastomoses with the posterior spinal artery t the C-4 or C-5 level were at a site dorsal to the posterior root of he spinal nerves [1,2]. There have been four reported cases of LSA aneurysm; all of hich presented with subarachnoid hemorrhage (SAH) (Table 1) 4–6]. The present report describes a case of a patient with an LSA neurysm associated with bilateral VA occlusion. Among the five ases, three were required sacrifice of the parent artery [4]. We iscuss the mechanisms underlying the formation of this aneurysm nd review optimal treatments.

A Case of Posterior Spinal Artery Syndrome in the Cervical Cord: A Review of the Clinicoradiological Literature

We describe a patient with posterior spinal artery (PSA) syndrome due to vertebral artery (VA) dissection. A 63-year-old woman developed neck pain, bilateral shoulder and arm numbness, and paraparesis after prolonged neck extension during a dental procedure. Neurological examination revealed sensory deficits in the legs, paraparesis, cerebellar ataxia, urinary retention and constipation. Magnetic resonance imaging disclosed T2-hyperintense lesions in the posterolateral C4-C7 cord with partial enhancement. T1-hyperintensity and stenosis were found in the right VA at C3-C5. These clinicoradiological findings suggested bilateral PSA syndrome and unilateral VA dissection. This is the fourth report of VA dissection-induced PSA syndrome.

A systematic study of the brain base arteries in the turkey (Meleagris gallopavo)

Thirty heads with neck segments of turkeys (Meleagris gallopavo) were dissected for a systematic study of the arteries. The frequency of the arteries found was: Cerebral carotid artery, intercarotid anastomosis and internal ophthalmic artery (100%). Caudal branch of the cerebral carotid artery to the right (R) vestigial artery (70%) and developed (30%) and to the left (L) developed (70%) and vestigial artery (30%). Ventral tectal mesencephalic artery in (70%) to R and (30%) to L was the direct branch of the cerebral carotid artery to L (70%) and to R (30%) collateral branch of the developed caudal branch. Basilar artery to L in (70%) and to R (30%) formed from the developed caudal branch; rostral ventral cerebellar artery present (86.7%) and absent (13.3%) to R and L. Caudal ventral cerebellar artery to R single (73.3%), double (23.3%) and triple (3.3%); caudal ventral cerebellar artery to L single (73.3%) and double (26.7%). Dorsal spinal artery branch of caudal ventral cerebellar artery to R (80%) and to L (73.3%). The rostral branch of cerebral carotid artery showed as collateral branches the single caudal cerebral artery to R (100%) and to L (96.7%) while in (3.3%) it was double. The middle cerebral artery was single to R and L (100%). Cerebroethmoidal artery to R and L (100%) with its collateral branch to single rostral cerebral artery (90%) to R and (86.7%) to L and double (10%) to R and (13.3%) to L. Ethmoidal artery to R and to L (100%) single. The cerebral arterial circle was rostrally and caudally opened, so that the cerebral blood supply was exclusively made by the carotid system.

Complex arteriovenous fistulas at C1 causing hematomyelia through aneurysmal rupture of a feeder from the anterior spinal artery

A 64-year-old woman presented with left occipital headache and right dissociated sensory loss due to hematomyelia on the left ventral side of C1 caused by rupture of an aneurysm on one of the feeders extending from the anterior spinal artery to complex epidural or dural and intradural arteriovenous fistulas (AVFs). Branches from the left occipital and ascending pharyngeal arteries and those from the left C2 radicular, left posterior spinal and anterior spinal arteries formed these multiple shunts, linking with a common venous drain flowing into the right petrosal vein. Surgical interception of all the shunts was achieved, making it unnecessary to directly treat the aneurysm in the spinal cord. The feeders, aneurysm and AVFs were not visualized on postoperative angiography, and the patient returned to a normal working life.

Contralateral axial lateropulsion and ocular tilt reaction in a cerebello-lateral medullary-spinal stroke

On 26 September 2010 a hypertensive, 66 year old male presented with an acute vestibular syndrome and headache of 4-h duration. Exam showed a crossed left face/right body hypoanalgesia and mild right axial lateropulsion. Initial brain magnetic resonance imaging (MRI) the same day showed acute infarction of the left cerebellar tonsil, gracile, and biventral lobe and of the caudal lateral medulla. He improved, but on 10 October 2010 developed worsening imbalance and could not sit without support due to severe right axial lateropulsion. On exam the next day, he had a right ocular tilt reaction (OTR), with a 3-prismdiopter hypotropic, excyclotropic right eye and low amplitude gaze evoked left-beat nystagmus. His subjective visual vertical (SVV) deviated 16 to the right. He had a normal head impulse test. New findings included profound absence of position and vibratory sense in the left upper and lower extremities, sensory ataxia, and mild left hemiparesis. Crossed hypoanalgesia was unchanged. Right axial lateropulsion corrected easily, without pushing behavior. Examination was otherwise unremarkable. Postural vertical (PV) and haptic vertical (HP) were not tested. On 15 October 2010, repeat brain MRI (Fig. 1) was unchanged, and cervical spine MRI (Fig. 2) revealed a postero-lateral cervical spinal cord stroke and altered signal within the left vertebral artery compatible with dissection. Follow-up examination 9 months later showed improved right axial lateropulsion, rightward OTR and 12 SVV deviation. He regained the ability to sit without support but could not stand. Findings for our patient provide an opportunity to assess the impact of near simultaneous altered gravitational perception, unilateral proprioceptive loss, and impaired postural compensation. To our knowledge, one previous case of a stroke involving arterial topography similar to our case has been reported [1]. These two cases also shared some clinical findings, representing a combination of lateral medullary (LMS), Opalski [2], and posterior spinal artery syndromes. Unique findings in our case, however, include contralateral body lateropulsion and OTR, and lengthy duration of axial balance impairment.

Clinical Core Symptoms of Posterior Spinal Artery Ischemia

Introduction: Ischemia in the distribution of the posterior spinal artery is rare. Methods: Between 2004 and 2008 we observed 4 patients with posterior spinal artery ischemia (PSAI). Results: All patients had the expected loss of posterior column function but also suffered from motor deficits which were severe, and the leading symptom in 2 patients. Severe pain, bowel and bladder dysfunction were other concomitant symptoms. In 3 of 4 patients, a follow-up spinal MRI was needed to show the cord infarct together with vertebral body ischemia in 2 patients. Conclusion: An acute onset of posterior column dysfunction with a variable degree of motor deficit and dorsalgia suggests PSAI.

Spinal ischaemic stroke: clinical and radiological findings and short‐term outcome

The mechanism and pathogenesis of ischemic spinal stroke remain largely undetermined because most clinical studies have included mostly patients without a systematic study of associated vascular and concomitant disease of the vertebral body. Therefore, we assessed the pathogenetic mechanisms and short-term outcomes of the patients with spinal stroke based on clinical data and magnetic resonance imaging findings. We studied clinical, imaging, and outcome data for 36 patients with acute spinal stroke admitted between 1998 and 2008. There were 16 men and 20 women (mean age 73, range 56-85 years). Twelve patients (33%) had anterior spinal artery patterns, 8 (22%) had anterior and 6 (17%) had posterior unilateral infarct, 5 (14%) had posterior spinal artery infarct pattern, 3 (8%) had central involvement, and 2 (5%) had transverse syndrome. Twelve patients (33%) had no cause of stroke. Patients with central infarct and transverse infarct had a high frequency of peripheral vascular disease and prolonged hypotension, and one patient each had a chronic spinal disease. The onset of all other infarcts was associated with mechanical triggering movements in 12 patients (41%, P<0.05), and with diseases of the spine in 19 (66%; P<0.001), with the clinical picture suggesting root involvement at the level of the spinal cord ischemia. The short-term outcomes were favorable in two-thirds of patients, while 25% of them did not show any recovery on leaving the hospital. The most common type of spinal cord ischemia is bilateral or unilateral anterior spinal artery infarcts due to radicular artery disease with acute or chronic spinal disease and followed by central and transverse infarcts due to extensive spinal cord hypoperfusion and arteriopathy.

Intracranial landmarks and other techniques to further improve the precision of stereotaxic tracer injections

This study is meant to combine traditional aspects of tracer microinjections using bone landmarks like bregma and lambda with novel procedures in which specific parts of the brain can serve as reference points. For telencephalic and diencephalic injections, the brain surface, the interhemispheric groove and the straight sinus can be used as absolute zero points for dorso-ventral, medio-lateral and rostro-caudal coordinates, respectively. In case of brainstem targets, the surface of the rhomboid fossa, the posterior spinal artery and the obex could serve as reference points along the above-mentioned coordinates. The application of high-precision stereotaxic measurements based on intracranial landmarks and sophisticated surgical procedures can yield well-targeted, small and well circumscribed injection sites that make possible the mapping of discrete nuclear subdivisions or delicate nuclei in the brain.

The intracranial denticulate ligament: anatomical study with neurosurgical significance

Knowledge of the detailed anatomy of the craniocervical junction is important to neurosurgeons. To the authors' knowledge, no study has addressed the detailed anatomy of the intracranial (first) denticulate ligament and its intracranial course and relationships. In 10 embalmed and 5 unembalmed adult cadavers, the authors performed posterior dissection of the craniocervical junction to expose the intracranial denticulate ligament. Rotation of the spinomedullary junction was documented before and after transection of unilateral ligaments. The first denticulate ligament was found on all but one left side and attached to the dura of the marginal sinus superior to the vertebral artery as it pierced the dura mater. The ligament always traveled between the vertebral artery and spinal accessory nerve. On 20% of sides, it also attached to the intracranial vertebral artery and, histologically, blended with its adventitia. In general, this ligament tended to be thicker laterally and was often cribriform in nature medially. The hypoglossal nerve was always superior to the ligament, which always concealed the ventral roots of the C-1 spinal nerve. The posterior spinal artery traveled posterior to this ligament on 93% of sides. On one left side, the ascending branch of the posterior spinal artery traveled anterior to the ligament and the descending branch traveled posterior to it. Following unilateral transection of the intracranial denticulate ligament, rotation of the spinomedullary junction was increased by approximately 25%. Knowledge of the relationships of the first denticulate ligament may prove useful to the neurosurgeon during procedures at the craniocervical junction.

Subarachnoid Hemorrhage following Posterior Spinal Artery Aneurysm

Isolated posterior spinal artery aneurysms are rare vascular lesions. We describe the case of a 43-year-old man presenting with spinal subarachnoid hemorrhage after a minor trauma who was found to have a dissecting aneurysm of a posterior spinal artery originating from the right T4 level. Endovascular treatment was not contemplated because of the small size of the feeding artery, whereas surgical resection was deemed more appropriate because of the posterolateral perimedullary location that was well appreciated on CT angiography. After surgical resection of the aneurysm the patient had a complete neurological recovery. In comparison to anterior spinal artery aneurysms whose pathogenesis is diverse, posterior spinal aneurysms are most often secondary to a dissection and represent false or spurious aneurysms. Although the definite diagnosis still requires spinal angiography, MRI and CT may better delineate the relationship of the aneurysm to the spinal cord in order to determine the best treatment method. Prompt treatment is recommended as they have high rebleeding and mortality rates.

Posterior Spinal Artery Infarct due to Patent Foramen Ovale

Case report. To report the first case of posterior spinal artery (PSA) infarct due to patent foramen ovale (PFO). Infarct in the territories of PSA are very rare: till now 38 cases are reported in the literature. Moreover only 1 case of spinal cord infarction was attributed to paradoxical embolism through PFO, but in the anterior spinal artery territory. A 60-year-old woman was hospitalized for sudden numbness of the right leg. Neurologic examination revealed right leg mild paresis and loss of proprioception and dysesthesia at T11. Spine-MRI showed T5-T7 posterolateral cord ischemia. Transesophageal echocardiography disclosed a PFO with severe right-left shunt confirmed by transcranial Doppler. During the hospitalization she was treated with oral-500 mg ticlopidine, because of a mild allergic reaction to acetylsalicylic acid. No steroids were administrated. Physiotherapy was performed daily. Motor and urinary symptoms disappeared in 20 days. At 1-month clinical follow-up only suspended dysesthesia on the right side was present. At 3 months follow-up spine-MRI showed no signal abnormalities within the spinal cord but the patient still complained of dysesthesia. The therapy was changed to oral 75 mg clopidogrel, cause of leucopoenia. At 1-year follow-up dysesthesia was still present, but less complaining and no recurrence and adverse effect due to clopidogrel therapy were reported. This report describe a case of acute nontraumatic myelopathy. At 4 days after onset, PSA infarct was diagnosed on the basis of neurologic findings and MR images. After extensive diagnostic work-up, we were able to identify only PFO, so it was the first case of PSA due to probable paradoxical embolism. The patient was treated with antiplatelet therapy with good recovery and no recurrence at 1-year follow-up.

帯状疱疹後に不完全型Ｂｒｏｗｎ−Ｓｅｑｕａｒｄ症候群を呈した１例

e report an 87-year-old woman who presented with incomplete Brown-Séquard syndrome after reactivation of varicella-zoster virus (VZV). Two days after herpes zoster in the right side of the chest, she developed weakness of the right lower limb. Neurological examination revealed a spastic palsy in the right lower limb and left side loss of pain and temperature sense to T6. However, vibration and position sense was not impaired in both sides. Spinal T2-weighted MR images showed a high-intensity lesion in the right side of the spinal cord except posL terior funiculus at the level of T2. Cerebrospinal fluid analysis showed 109 leukocytes/mm3, 79 mg/dl protein, negative VZV PCR, elevated titer of anti-VZV IgM and IgG, and increase of IgG index. Although she was treated with a combination of acyclovir and steroid pulse therapy, her weakness in the right lower limb was not improved. In this case, since the posterior funiculus circulated from the posterior spinal artery was not involved, the incomplete Brown-S6quard syndrome may be caused by spinal cord infarction due to VZV vasculitis of the anterior spinal artery.

Isolated posterior spinal artery aneurysm causing intracranial acute subarachnoidal hemorrhage

A case of an isolated posterior spinal artery aneurysm of the upper cervical spinal cord is presented. Spinal artery aneurysms that are not associated with other entities are extremely rare. Four cases have been reported in the literature to date. The patient developed symptoms and signs of intracranial subarachnoid hemorrhage. The aneurysm was successfully clipped. No other vascular abnormalities were seen.