Presentation
Right arm pain with posterior motor deficit.
Patient Data
Cervical spine revealed intramedullary T2 hyperintensity at C5-C6 with restricted diffusion (on axial and sagittal images) over the lateral aspect of the right hemicord. On T1-weighted post-contrast images, there is mild enhancement. This finding is suggestive of medullary infarction.
Disc protrusions at C5-C6 and C6-C7.
Case Discussion
Spinal cord ischemia is a really rare entity, and the most common artery involved is the anterior spinal artery. When the anterior spinal artery is implicated, there are some specific patterns but the most frequent are the impairment of the anterior and central portions of the cord bilaterally resulting in the owl-eyes sign.
The sulcal arteries are penetrating branches from the anterior spinal artery which supply the anterior two thirds of the cord, on one side, right or left, resulting from their impairment in an incomplete Brown-Séquard syndrome.
The sulcal artery syndrome is produced by spinal cord infarction involving the territory of one of the sulcal arteries.
Cervical cord infarction is associated with vertebral artery dissection and this needs to be ruled out.
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