Bilateral posterior medullary and cervical stroke: a case report

Area of Science:

• Neurology
• Vascular Neurology
• Neuroimaging

Background:

• Spinal strokes typically affect the anterior spinal artery territory.
• Posterior spinal artery (PSA) strokes are uncommon and usually unilateral.
• Bilateral PSA strokes are exceptionally rare.

Observation:

• A 70-year-old woman presented with cervical pain, sensory deficits (hypoesthesia, ataxia) after mild head trauma.
• Neurological deficits progressed to involve the entire body, including the face.
• Doppler ultrasound revealed diminished flow in the left vertebral artery (VA).

Findings:

• MRI confirmed bilateral infarction in the posterior spinal artery territory, from the medulla oblongata to C4.
• A hypoplastic left vertebral artery (VA) with non-visualized V3 segment was identified.
• The findings suggest a bilateral PSA stroke possibly secondary to left VA dissection, with a dominant PSA arising from the hypoplastic VA.

Implications:

• This case underscores the potential for rare vascular events like bilateral PSA strokes.
• Highlights the role of vertebral artery dissection and anatomical variations (hypoplastic VA, dominant PSA) in spinal stroke etiology.
• Emphasizes the importance of advanced neuroimaging in diagnosing complex spinal vascular pathologies.