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Cervical spinal cord infarction due to impingement of an anomalous right vertebral artery by thoracic osteophyte

Abstract

Introduction

Spinal cord infarction in a young, otherwise healthy individual is a rare occurrence. The anterior spinal artery and posterior spinal arteries are the primary contributors to the vascular supply of the cervical supply, and these arteries arise as descending branches of the vertebral arteries. Historically, many cases have demonstrated individual variations in the vertebral arteries, such as differences in dominancy, patency, origin, and insertion. The clinical significance of these variations remains poorly understood.

Case presentation

We present a patient who sustained a spinal cord infarction at C2–C5 resulting in incomplete quadriplegia. The mechanism of injury was unclear, although the patient reported an awkward jumping motion earlier that day that preceded the onset of upper extremity weakness. After resolution of the acute phase, he was diagnosed with “Man-in-the-Barrel” syndrome. Angiographic evaluation revealed an anomalous non-dominant right vertebral artery with several pathological features: origin at the descending aorta, insertion into the right posterior inferior cerebellar artery, and impingement along its course by an anterior thoracic osteophyte.

Discussion

The vertebral arteries play an important role in the vascular supply of the cervical spine. While vertebral artery pathology such as dissection or occlusion have been documented in rare cases to result in spinal cord infarction, this case illustrates an example of clinically significant sequelae that can occur in the setting of anomalous vertebral arteries even in the absence of occlusion or dissection. Furthermore, to our knowledge this is the first reported case of a spinal cord infarction resulting from osteophytic vertebral artery impingement.

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Acknowledgements

We would like to acknowledge Patricia Delgado, M.D. from the University of Puerto Rico for her assistance in interpreting the radiographic studies included in this case report.

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AM contributed to conducting pertinent review of the literature, writing the report (especially later drafts/revisions), and compiling/including references appropriately. HM contributed to conducting a literature review, formulation of the first draft, and provided feedback for subsequent draft revisions. JD contributed by identification of the case for publication, providing mentorship during the manuscript writing process, and delivering appropriate feedback for draft revisions.

Corresponding author

Correspondence to Abhinav Mohan.

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The authors declare no competing interests.

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Informed consent was obtained from the patient. The purpose of this paper was explained, and the patient was ensured that all identifying information will be removed.

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Mohan, A., Mielke-Maday, H. & Delgado-Lebron, J. Cervical spinal cord infarction due to impingement of an anomalous right vertebral artery by thoracic osteophyte. Spinal Cord Ser Cases 7, 95 (2021). https://doi.org/10.1038/s41394-021-00457-8

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