Circle of Willis variation in a complex stroke presentation: a case report

BACKGROUND: The impact of circle of Willis anatomical variation upon the presentation of stroke is probably underrecognised. CASE PRESENTATION: A 63-year-old right-handed woman developed a left hemiparesis and right leg weakness sequentially following a road traffic accident (RTA). Despite initial concern about the possibility of cervical spinal cord injury, the final diagnosis was bilateral artery-to-artery embolic cerebral infarction with dominant right internal carotid artery. CONCLUSION: The case illustrates the complex presentation of stroke as a pseudo-cervical cord lesion and the impact of circle of Willis anatomical variation upon the expression of large vessel cerebrovascular disease

Secondary medulla oblongata involvement following middle cervical spinal cord injury associated with latent traumatic instability in a patient with ossification of the posterior longitudinal ligament

Study design: A case report. Objectives: To report a rare case of extension of edema and hemorrhage from initial C4–5 spinal injury to the medulla oblongata. Setting: Center for Spinal Disorders and Injuries, Bibai Rosai Hospital, Japan. Methods: A 68-year-old man with ossification of the posterior longitudinal ligament (OPLL) had sustained tetraplegia after tumbling over a stone. Initially, the patient was diagnosed with an acute C4–5 spinal cord injury without radiological abnormalities and was treated conservatively. At 7 h after the injury, the patient had an ascending neurological deficit, which required respiratory assistance. Magnetic resonance imaging revealed a marked swelling of the spinal cord above C4–5 extending to the medulla oblongata. Results: Retrospective radiological assessment revealed that the spine was unstable at the injury level because of discontinuities in both anterior and posterior longitudinal ligaments. There was also signal intensity change within the retropharyngeal space at the C4–5 intervertebral disc. This injured segment was highly vulnerable to post-injury dynamic stenosis and easily sustained secondary neural damage. Conclusions: This case report emphasizes a careful radiological assessment of latent structural instability in patients with OPLL in order to detect and prevent deteriorative change in the spinal cord

Morphometric analyses of the cervical superior facets and implications for facet dislocation

The articular facets of the cervical spine have been well addressed; however, little information is available on the relationship of the superior facets of the cervical spine to traumatic dislocation in the literature. Morphometric analyses of the superior facets of 30 dried cervical spines from C3 to C7 were performed to determine any morphological differences. The angle of the superior facet with respect to the transverse plane was also measured on computed tomography (CT) scans of 30 patients having neck injury without fracture/dislocation. The vertical and surface lengths of the superior facet were significantly lower (P < 0.01) at C6–C7 levels than at C3–5 levels. The anteroposterior diameter of the superior facet was smaller (P < 0.05) at C6 and C7 levels compared to C3–5 levels. Although the superior facet joint surface is in a more coronal orientation in lower cervical vertebrae, the inclination of the superior facet is more horizontal relative to the transverse plane when measured in vivo. A combination of lower height, smaller anteroposterior diameter of the superior facet, and a more horizontally oriented superior facet at C6 and C7 levels in vivo may explain the predilection of translation relative to one another in the lower cervical spine