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Ischemic Cervical Myelopathy Caused by Vertebral Artery Dissection: The Clinical Utility of a Motor-evoked Potential
Woo Hyung Lee1, Shi-Uk Lee, Se Hee Jung
1*Department of Rehabilitation Medicine, Seoul National University Hospital ‡Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center †Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea.
Insights
Vertebral artery dissection (VAD) can cause stroke and rarely spinal cord issues. Motor-evoked potential studies aid in diagnosing these complex neurological complications of VAD.
Area of Science:
- Neurology
- Vascular Neurology
- Neurophysiology
Background:
- Vertebral artery dissection (VAD) is an emerging cause of ischemic stroke, particularly in younger adults.
- VAD can rarely lead to spinal cord ischemia, presenting as cervical myelopathy.
Observation:
- A 51-year-old male presented with right upper extremity weakness, sensory loss, neck pain, headache, dizziness, and ataxia.
- Cerebral MRI revealed cerebellar and temporo-occipital infarcts; MR angiography confirmed right VAD.
- Electrophysiological studies, including motor-evoked potentials, indicated prolonged conduction times, suggesting cervical myelopathy.
Findings:
- Cervical spinal MRI showed high signal intensity in the right anterior column at C3-C4, confirming cervical ischemic myelopathy.
- The electrophysiological findings helped differentiate between upper and lower motor neuron involvement.
Implications:
- Motor-evoked potential studies are valuable in diagnosing peripheral neurological complications in VAD when clinical presentation is ambiguous.
- This case highlights the importance of considering spinal cord involvement in VAD and utilizing neurophysiological tools for accurate diagnosis.
Introduction:
Vertebral artery dissection (VAD) has been increasingly recognized as one of the important causes of ischemic stroke especially in young and middle-aged population. Rarely, VAD can involve the spinal cord, causing ischemic cervical myelopathy.
Case Report:
A 51-year-old man presented with sudden onset of weakness and hypesthesia involving right upper extremity, accompanied by posterior neck pain and headache. He also complained nonwhirling type of dizziness and nausea and he exhibited ataxic gait. Brain magnetic resonance imaging showed acute infarction at the right cerebellar hemisphere and temporo-occipital lobe. Right VAD was identified by MR angiography and confirmed by transfemoral cerebral angiography. Because the selective proximal weakness of the right upper extremity and hypesthesia at C5 and C6 dermatomes was not be fully explained by the brain lesion, electrophysiological studies were performed. The motor-evoked potential studies revealed that the latency and central motor conduction time was prolonged in the right cervical and lumbosacral roots. These studies implied cervical myelopathy involving the right anterior column. Magnetic resonance imaging of the cervical spine demonstrated high signal intensity of the right anterior column at C3-C4 level, which confirmed cervical ischemic myelopathy.
Conclusions:
When there is diagnostic ambiguity between the upper and lower motor neuron lesions in VAD, motor-evoked potential study can be helpful to diagnose peripheral neurological complication of VAD.
