J Clin Neurol.  2014 Apr;10(2):171-173. 10.3988/jcn.2014.10.2.171.

Atypical Anterior Spinal Artery Infarction due to Left Vertebral Artery Occlusion Presenting with Bilateral Hand Weakness

• Kim MJ
• Jang MH
• Choi MS
• Kang SY
• Kim JY
• Kwon KH
• Kang IW
• Cho SJ

• KMID: 2287537
• DOI: http://doi.org/10.3988/jcn.2014.10.2.171

Abstract

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.

Keyword

spinal cord infarction; vertebral artery occlusion; hands; anterior spinal artery

MeSH Terms

Adult
Arteries*
Brain
Fingers
Hand*
Humans
Infarction*
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Neck Pain
Spinal Cord
Spine
Vertebral Artery*
Wrist

Figure

• 

  Fig. 1 A: Severe stenosis and occlusion of the proximal part of the left vertebral artery in a neck CT angiogram. B: Axial T2-weighted image showing severe stenosis of the left vertebral artery due to dissection, showing a pseudo lumen with mural thrombi (arrow), and a high signal intensity in the left gray matter of spinal cord at the C4 level.

• 

  Fig. 2 A: Sagittal T2-weighted MRI image of the cervical spine showing an abnormal area of high signal intensities at the C3, C4, and C6 levels. B: Diffusion-weighted image showing high signal intensities on the left side at the C3 and C4 levels.

• 

  Fig. 3 Approximate locations of the motor neurons in the anterior gray horn of the cervical cord.

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