036 A rare subtype of a rare type of stroke - sulcal artery syndrome

A 78 year old man was woken from sleep by a sudden excruciating neck pain. The pain was accompa- nied by left arm and leg weakness and paraesthesia which progressed to maximum intensity over hours. His past medical history was significant for ischaemic heart disease and type 2 diabetes. On examination there was an incomplete Brown-Sequard syndrome localising to the left hemicord. MRI of the cervical spine showed intramedullary T2 hyperintensity and restricted diffusion in the left hemicord at C2-C3 level. CT angiogram of the vertebral arteries excluded dissection. We diagnosed acute spinal cord infarction due to a sulcal artery occlusion, and treated with antiplatelets and secondary stroke prevention. The neurological deficit improved significantly over the following days. Spinal cord strokes are diagnostic challenges and account for only 1.25% of all strokes. Sulcal artery syndrome is a rare cause of spinal cord infarction, involving the territory of the sulcal arteries, which are paired penetrating branches of the anterior spinal artery and perfuse the anterior two-thirds of half the spinal cord. An acute onset with pain is an important clue - otherwise the hemi-distribution and short segment of signal change may be misdiagnosed as an inflammatory lesion. myat win@nhs.net 43
Source: Journal of Neurology, Neurosurgery and Psychiatry - Category: Neurosurgery Authors: Tags: Live Poster, 13 May Poster Session 1 Source Type: research