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Clinical features and outcomes of spinal cord infarction following vertebral artery dissection: a systematic review of the literature.
MedLine Citation:
PMID:  23562138     Owner:  NLM     Status:  Publisher    
OBJECTIVE: Spinal cord infarction (SCI) is a rare complication of vertebral artery dissection (VAD). Its clinical features and outcomes have not yet been well documented. METHODS: In addition to reporting a case with bilateral SCI caused by left VAD, we performed a systematic review of the literature conducted through a PubMed search. RESULTS: A total of 17 cases were reviewed (nine men and eight women). The average age was 40.5±14.6 years. In addition to neck pain or headache (88%), patients with VAD-associated SCI often presented with a sensory level (76%) or Brown-Séquard syndrome (53%). The most common regions of dissection were at the V1 or proximal V2 segments, and the infarcted area of SCI was mainly located at C2-C5 levels. Regarding the vascular territory, posterior spinal artery infarction was noted in 29% of patients, spinal sulcal artery infarction in 42%, and anterior spinal artery (ASA) watershed infarction in 29%. Eleven patients (65%) had a good outcome and six patients (35%) had a poor outcome (including one mortality; 6%). Smoking, age above 50 years, and ASA watershed infarction were associated with a poor outcome, while spinal sulcal artery infarction was associated with a good outcome. CONCLUSION: Neck pain or headache is an important warning symptom of VAD, and the presence of a concomitant sensory level or Brown-Séquard syndrome is helpful for the early diagnosis of SCI caused by VAD. One-third of patients had a poor outcome, and smoking, old age, and ASA watershed infarction represented important risk factors.
Chia-Yu Hsu; Chun-Yu Cheng; Jiann-Der Lee; Meng Lee; Ying-Chih Huang; Chih-Ying Wu; Huan-Lin Hsu; Ya-Hui Lin; Yen-Chu Huang; Hsu-Huei Weng; Kuo-Lun Huang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-3-12
Journal Detail:
Title:  Neurological research     Volume:  -     ISSN:  1743-1328     ISO Abbreviation:  Neurol. Res.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-4-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7905298     Medline TA:  Neurol Res     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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