A Case Report of an Acute Myelopathy highly suspected of Unilateral Anterior Spinal Artery Syndrome

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  • 片側性前脊髄動脈症候群と考えられた急性脊髄障害の1例

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Anterior spinal artery syndrome of the cervical hemicord is very rare and there have been few reports in the literature. A 63-year-old woman was admitted for left arm numbness and gait disturbance. On admission, she showed severe dysesthesia in her left arm, mild left hemiparesis, right-sided hypalgesia and thermohypesthesia below T-1 level. Magnetic resonance (MR) imaging of the cervical spine showed a high intensity lesion on both diffusion-weighted and T2-weighted images in the left ventral portion of the spinal cord at C-7. Serologic test for syphilis, antinuclear antibodies and anticardiolipin antibody were negative. Serum IgM titers for various viral antigens were also negative. In addition, CSF analysis including tests for oligoclonal band and for myelin basic protein were normal. Therefore, we suspected unilateral infarction of the cervical cord and immediately administered corticosteroid and antihypertonic agent. She developed right hemiplegia one week later, however, her motor symptoms gradually improved in the two weeks after her admission. She was discharged on foot with minimal left hemiparesis predominantly revealed in the fingers of her left hand and persistent right hemisensory disturbance 60 days after onset. Although anterior spinal artery syndrome of the cervical hemicord is extremely rare, prompt diagnosis using diffusion-weighted MR imaging and immediate treatment may ameliorate the functional outcome.

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