2026 American Academy of Neurology Abstract Website

Objective:

Background:

Spinal artery infarcts (SCIs) comprise 1-1.5% of all ischemic strokes, the majority of which are traumatic. Of all SCIs, both traumatic and spontaneous, anterior spinal artery infarcts are most common. Identified risk factors for nontraumatic SCIs include hypertension, atherosclerosis, aortic dissection, and iatrogenic procedures. However, most studies pool both anterior and posterior spinal artery (PSA) SCIs together.

In 2018, The Mayo Clinic published the largest analysis of spontaneous SCIs. Of the 133 spontaneous SCIs reported, only 15 patients had PSA infarctions, one of which was less than 50-years-old.

Design/Methods:

Results:

A 36-year-old woman with a history of preeclampsia and remote tobacco use presented with headache and neck pain. She was discharged from the emergency department (ED) after symptomatic improvement. She returned to the ED hours later with worsening headache, associated with photophobia, vomiting, and right hemisensory disturbance. Blood pressure was 210/112mmHg. The differential diagnosis of posterior reversible encephalopathy syndrome, hypertensive urgency, or migraine was entertained. CT head was unremarkable. Magnetic resonance(MR) imaging revealed an acute infarct of the right posterior cervical cord. MR angiography revealed bilateral vertebral artery (VA) dissections of the V3-segments. Subsequent workup was otherwise unremarkable. She was treated with aspirin and clopidogrel.

Conclusions:

PSA infarcts are exceedingly rare, accounting for less than 0.2% of ischemic strokes. As in our patient, the vague presenting symptoms of PSA infarcts could potentially lead to a delay in diagnosis; therefore, we postulate that the incidence may be higher than reported. Spontaneous VA dissections are also rare, with over 90% of dissections propagating intracranially. Our case is unique, as it illustrates a rare sequela of bilateral VA dissections leading to unilateral PSA infarction.

Early identification of spontaneous bilateral VA dissections and increased awareness of the easily overlooked potential sequelae of PSA infarctions would facilitate efforts to mitigate diagnostic delay and ensure appropriate management.