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Cervical anterior spinal artery infarction associated with anomalous vertebral artery: a case report

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Abstract

We report a unique case of cervical anterior spinal artery (ASA) infarction in a 49-year-old male with hypercholesterolemia and sleep apnea. The patient experienced sudden cervical pain, quadriparesis, areflexia, and urinary incontinence after swallowing a large food bolus. Imaging revealed an infarction at the C3–C5 levels and an anomalous right vertebral artery (VA) originating from the thoracic aorta, tightly enclosed between the aorta and a vertebral column with an anterior osteophyte. This aberrant VA was the primary vascular supply to the ASA, with no contribution from the left VA or supreme intercostal arteries. We propose that transient injury to the right VA, induced by compression between the aortic arch, the food bolus, and the osteophyte, led to temporary hypoperfusion of the ASA, causing a watershed ischemic injury in the mid cervical cord’s anterior gray matter. The article also provides an in-depth discussion of the developmental and clinical characteristics associated with this rare vascular anomaly.

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Abbreviations

ASA:

Anterior spinal artery

ASAS:

Anterior spinal artery syndrome

VA:

Vertebral artery

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Authors and Affiliations

  1. Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    Edinson Najera & Michal Obrzut

  2. Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Stephen J. Bordes

  3. Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA

    Philippe Gailloud & Lydia Gregg

  4. Department of Neurology, Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA

    Maria Martucci

Authors
  1. Edinson Najera
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  2. Stephen J. Bordes
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  3. Philippe Gailloud
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  4. Lydia Gregg
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  5. Maria Martucci
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  6. Michal Obrzut
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Correspondence to Michal Obrzut.

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Najera, E., Bordes, S.J., Gailloud, P. et al. Cervical anterior spinal artery infarction associated with anomalous vertebral artery: a case report. Neuroradiology 66, 431–435 (2024). https://doi.org/10.1007/s00234-023-03277-9

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  • DOI: https://doi.org/10.1007/s00234-023-03277-9

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