Long-segment cervicothoracic spinal cord injury occurring after cerebral angiography: a case report

Spinal cord injury (CIS) is an exceedingly rare complication of cerebral angiography, with only nine cases since 1962. Pathogenesis remains poorly understood.

A 67-year-old diabetic woman presented with dizziness and normal neurological examination. During cerebral angiography, repeated injections of ioversol contrast medium (total 100 mL; approximately 20 min at a single site) were performed into the right subclavian artery for vertebral artery imaging due to vascular tortuosity. The angiography showed normal cerebrovascular morphology, without emboli, stenosis, vasospasm, or dissection. Four hours post-procedure, she developed neck pain and limb weakness progressing to quadriplegia (upper limb strength 3/5, lower limb 2/5) within 10 h. Serial MRI demonstrated longitudinal extension: from C1-C3 cord swelling (10 h) to medulla-T3 hyperintensity (24 h). Dynamic angiography revealed aberrant anastomoses between the thyrocervical trunk-ascending cervical artery and V2-segmental-anterior spinal arteries. Despite high-dose methylprednisolone and intravenous immunoglobulin, motor strength deteriorated (upper limbs 3/5, lower limbs 0/5) without recovery at 1 year.

This case reports a long-segment cervicothoracic CIS following cerebral angiography. Abnormal spinal collateral circulation may have delivered contrast medium to the spinal cord and thereby possibly contributing to the extensive injury observed. This outcome highlights the need for extreme caution with repetitive contrast injections at a single site.