Background Whilst often causing posterior circulation strokes, vertebral artery dissections may also, more rarely, cause spinal cord infarction.1 This is the case report of a 39-year-old female with a right-sided high cervical hemi-cord infarction caused by vertebral artery dissection of a hypoplastic right vertebral artery.
Presentation A 39-year-old female with a history of migraines, presented with acute onset right neck pain, headache and right-sided paraesthesia of the arm and leg after rapid rotation of the neck to the left. Due to a headache similar to her usual migraine, the patient took Rizatriptan prior to presentation. Neurological examination revealed findings, including right-sided upper and lower limb paraesthesia, weakness and dysmetria, consistent with right hemi-cord infarction. CT angiogram of the neck and brain revealed a small calibre right vertebral artery of unclear aetiology. Subsequent MRA revealed a hypoplastic right vertebral artery with dissection causing a high cervical right hemi-cord infarction. The patient’s right sided paraesthesia and weakness slowly improved over three months with medical therapy and rehabilitation, however some deficits remain, which affect her quality of life.
Conclusion This unusual case is a poignant reminder to carefully consider alternative diagnoses that may mimic migraines, especially when neurological signs and symptoms are present. Such differential diagnoses, such as vertebral artery dissection and spinal cord infarction, are of particular importance to consider, even in young patients without any risk factors, given that they can cause significant disability which may impact on quality of life.2
Hsu J, Cheng M, Liao M, Hsu H, Weng Y, Chang K, et al. The etiologies and prognosis associated with spinal cord infarction. Annals of Clinical and Translational Neurology 2019;6(8):1456–1464.
Hsu C, Cheng C, Lee J, Lee M, Huang Y, Wu C, et al. Clinical features and outcomes of spinal cord infarction following vertebral artery dissection: a systematic review of the literature. Neurological Research 2013;35(7):676–683.
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