November 14, 2011
72-year-old man with sudden-onset sensory disturbance and deficits in proprioception in the left arm and leg.
Posterior Spinal Artery Syndrome Following Thrombotic Occlusion of the Vertebral Artery
- Anterior spinal artery occlusion is relatively common. Most such occlusions involve the anterior two-thirds of the spinal cord.
- A rarer ischemic cord event is the posterior spinal artery syndrome, which in the cervical spine results from vertebral artery occlusion/dissection. Usually bilateral, unilateral event is rare.
- Patients present with deficits in vibration and proprioception.
- CSF analysis is usually normal except for elevation in protein.
- Key Diagnostic Features: MRI demonstrates increased signal involving the posterior aspect of the cord, which can extend to involve the posterior medulla. Diffusion restriction can be seen in acute cases. Associated thrombotic occlusion/dissection of the ipsilateral vertebral artery will be seen.
- Rx: Supportive. Prognosis is usually good with significant improvement at short-term with minimal or no neurologic deficits.
