title: Clinical features and outcomes of spinal cord infarction following vertebral artery dissection: a systematic review of the literature.
abstract: OBJECTIVE
  Spinal cord infarction (SCI) is a rare complication of vertebral artery dissection (VAD). Its clinical features and outcomes have not yet been well documented.
  
  
  METHODS
  In addition to reporting a case with bilateral SCI caused by left VAD, we performed a systematic review of the literature conducted through a PubMed search.
  
  
  RESULTS
  A total of 17 cases were reviewed (nine men and eight women). The average age was 40·5±14·6 years. In addition to neck pain or headache (88%), patients with VAD-associated SCI often presented with a sensory level (76%) or Brown-Séquard syndrome (53%). The most common regions of dissection were at the V1 or proximal V2 segments, and the infarcted area of SCI was mainly located at C2-C5 levels. Regarding the vascular territory, posterior spinal artery infarction was noted in 29% of patients, spinal sulcal artery infarction in 42%, and anterior spinal artery (ASA) watershed infarction in 29%. Eleven patients (65%) had a good outcome and six patients (35%) had a poor outcome (including one mortality; 6%). Smoking, age above 50 years, and ASA watershed infarction were associated with a poor outcome, while spinal sulcal artery infarction was associated with a good outcome.
  
  
  CONCLUSIONS
  Neck pain or headache is an important warning symptom of VAD, and the presence of a concomitant sensory level or Brown-Séquard syndrome is helpful for the early diagnosis of SCI caused by VAD. One-third of patients had a poor outcome, and smoking, old age, and ASA watershed infarction represented important risk factors.
authors.affiliation: Chang Gung Memorial Hospital, Yunlin, Taiwan.
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Hsu
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Cheng
authors.forename: Jiann-Der
authors.initials: JD
authors.lastname: Lee
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
authors.forename: Ying-Chih
authors.initials: YC
authors.lastname: Huang
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Wu
authors.forename: Huan-Lin
authors.initials: HL
authors.lastname: Hsu
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Lin
authors.forename: Yen-Chu
authors.initials: YC
authors.lastname: Huang
authors.forename: Hsu-Huei
authors.initials: HH
authors.lastname: Weng
authors.forename: Kuo-Lun
authors.initials: KL
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007238:Infarction / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000098:blood supply*; D020217:Vertebral Artery Dissection / Q000150:complications*; D055815:Young Adult