[Spinal cord infarction presenting Brown-Séquard syndrome with impaired position sense]

A 79-year-old hypertensive man presented left hemiplegia of sudden onset. Neurological examination revealed weakness of the left extremities, with hypoalgesia on the opposite side below the level C 4. He also showed Horner syndrome, facial hypoalgesia, weakness of sternocleidmastoid and trapezius muscles on the paralyzed side. The position and vibration senses were impaired on the left extremities. The position sense was more disturbed on his upper limb, to the extent that the patient was not able to recognize where his wrist was located. The cervical MRI exhibited a high signal intensity on the left half of the cord between C 2-C 5 vertebral level on T 2 WI. Bilateral vertebral arteries were patent, though severe stenosis of internal-external carotid artery bifurcation was observed on MRA. Asymmetrical distribution of upper cervical cord arteries, severe atherosclerotic change of cervical and intracranial vessels, and spondylotic cervical canal stenosis were suggested to contribute to cause the lateralized infarction of the cord, involving not only the anterior, but also posterior part, where Burdach's fascicle were probably more affected.