[Anterior spinal artery syndrome: an important differential diagnosis of acute non-traumatic transverse spinal cord syndrome].
We report on a 77-year-old man who was suffering from pain in the chest, which was initially circumferential, along with paresthesia in his left leg, a fluctuating spastic paraparesis and dissociated sensory disturbances caudal to segment T8. In his history, he had received an aortoiliac Y-prothesis for a ruptured retroperitoneal intrarenal aortic aneurysm 39 months previously. Diagnostically, magnetic resonance imaging of the spine revealed advanced degenerative changes with osseous stenoses in segments C5-6 and less pronounced on C6-7. There were no signs of myelopathy. The results of the computerized tomogram of the neurocranium were consistent with the patient's age. The computerized tomogram of the chest and abdomen revealed a left outward bulge in the descending branch of the thoracic artery that was almost 20 mm in length. Based on the differential diagnosis, this was interpreted as an aneurysmatic sacculation with wall thrombosis or a locally circumscribed intramural hematoma upon dissection. Electrophysiologic testing by conduction of magnet-evoked potentials showed no lesions of the pyramidal tract to the extremities above the lumbosacral level. Lumbosacral stimulation evoked potentials on both sides whereas cortical stimulation did not. Based on the patient's history, the clinical findings and additional tests, the diagnosis of anterior spinal artery syndrome was rendered although its cause could not be determined with certainty. The previous transitory ischemic attack and the varying course of the disease is very exceptional in the presented case.
Schaller
B
B
Neurologische Universitätsklinik, Kantonsspital Basel.
Lyrer
P
P
D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis*; D020759:Anterior Spinal Artery Syndrome / Q000175:diagnosis*; D001011:Aorta / Q000473:pathology; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis*; D001019:Aortic Rupture / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010264:Paraplegia / Q000175:diagnosis*; D011183:Postoperative Complications / Q000175:diagnosis*; D013116:Spinal Cord / Q000473:pathology