Posterior spinal artery syndrome showing marked swelling of the spinal cord: A clinico-pathological study

Abstract

Objective: To describe a rare autopsy case of posterior spinal artery syndrome with marked swelling of the spinal cord, an unusually subacute onset and short clinical course. Methods: Case report. Findings: An 84-year-old Japanese woman presented with bilateral muscle weakness of the lower legs and sensory disturbance 1 week after head contusion. Neurological findings worsened gradually. She developed phrenic nerve paralysis and died of respiratory failure 6 weeks after the onset of neurological symptoms. On pathological examination, the spinal cord was markedly swollen in the cervical and upper thoracic segments. Microscopically, there was loss of myelin sheath in the bilateral posterior columns and neuronal loss of the posterior horns in all of the spinal segments. However, findings were unremarkable in the bilateral anterior columns and bilateral anterior horns in most of the spinal segments. Posterior spinal arteries had no stenosis, occlusion, or thrombosis. We considered that pathogenesis was infarction associated with head injury. Conclusion: To our knowledge, this is the first report of a case of posterior spinal artery syndrome with a markedly swollen spinal cord and poor prognosis.

WITHDRAWN: Changes of the F-wave in the acute phase of permanent spinal cord ischaemic injury predict spinal cord function in animal models of rabbits

“…The posterior 1/3 of the spinal cord is supplied with blood by two continuously posterior spinal arteries [15], whereas the anterior 2/3 is supplied with blood by an intermittent anterior spinal artery [16]. As a result of the good continuity of the posterior spinal artery and many posterior root arteries, the possibility of ischaemia being generated in the posterior spinal artery is very small, but the damage of the root artery mainly has an impact on the anterior 2/3 spinal cord [17].…”

The etiologies and prognosis associated with spinal cord infarction

“…Pure PSA infarction in SCI is relatively rare based on previous case studies . Multiple etiologies of PSA infarction have been previously reported; these include atherosclerosis, fibrocartilaginous embolization, head injury, or mitral valve strands. In a recent study that comprised the largest series of PSA infarctions (133 patients with SCI), 15 (11%), patients had a spontaneous PSA infarction .…”

Hyperextension‐Induced Dorsal Cord Syndrome: Case Presentation

“…Dorsal cord involvement only accounts for 11% of all spinal cord infarctions . PSA infarcts have been reported after meningovascular syphilis, phenol intrathecal injection, minor indirect trauma, and secondary aortic or vertebral artery disease . PSA infarct within the cervical spinal cord, as seen with our patient, is exceedingly less common with the reported cases summarized in Table .…”