Combined cerebellar and spinal ischemic stroke is a rare, critical condition. We report a patient with combined cerebellar and bilateral posterolateral cervical spinal cord infarction due to bilateral stenosis of the vertebral arteries. MRI is the method of choice for imaging this condition; diffusion-weighted imaging of the spinal cord gives reliable results

Brückmann, H.

Hamann, Gerhard F.

Liebetrau, M.

Müller-Schunk, S.

Reich, P.

Scheuerer, W.

English

Universität München: Elektronischen Publikationen

Case Report
Cerebrovasc Dis 2003;15:143–147
DOI: 10.1159/000067143
Combined Cerebellar and Bilateral
Cervical Posterior Spinal Artery Stroke
Demonstrated on MRI
P. Reicha S. Müller-Schunkb M. Liebetraua W. Scheuerera H. Brückmannb
G.F. Hamanna
Departments of aNeurology and bNeuroradiology, Klinikum der LMU München, Grosshadern, Munich, Germany
Received: October 10, 2001
Accepted: June 21, 2002
G.F. Hamann, MD
Department of Neurology, Klinikum der LMU München
Standort Grosshadern, Marchioninistrasse 15
D–81377 Munich (Germany)
Tel. +49 89 70953670, E-Mail hamann@brain.nefo.uni-muenchen.de
ABC
Fax + 41 61 306 12 34
E-Mail karger@karger.ch
www.karger.com
© 2003 S. Karger AG, Basel
1015–9770/03/0152–0143$19.50/0
Accessible online at:
www.karger.com/ced
The authors wish to thank Mrs J. Benson for editing the English
text.
Key Words
Spinal cord stroke W Posterior spinal artery W Vertebral
artery stenosis W MRI, diffusion-weighted
Abstract
Combined cerebellar and spinal ischemic stroke is a rare,
critical condition. We report a patient with combined cer-
ebellar and bilateral posterolateral cervical spinal cord
infarction due to bilateral stenosis of the vertebral arter-
ies. MRI is the method of choice for imaging this condi-
tion; diffusion-weighted imaging of the spinal cord gives
reliable results.
Case Report
A 64-year-old woman with a history of hypertension, hypercho-
lesterolemia and insulin-dependent diabetes mellitus was admitted
to the hospital after sudden onset of vertigo, nausea, vomiting and
elevated blood pressure. Cranial CT scan showed hypodensity of the
right cerebellar hemisphere within the territory of the right posterior
inferior cerebellar artery. Seven days later, the patient noted pares-
thesia of her right arm, followed by weakness of her right arm and
leg.
The neurological examination showed (a) a cerebellar hemisphere
syndrome with rotatory vertigo, nausea, occipital and nuchal head-
ache, symmetrical and horizontal gaze-evoked nystagmus, saccadic
smooth pursuit in all directions, dysarthria, ataxia and dysmetria of
the right side, as well as (b) brainstem involvement with perioral
hypesthesia. In addition, paresis of the right upper and lower limbs
(3/5) without facial involvement and paresthesia of the right arm
were observed. The muscle stretch reflexes on the right side were
increased, and the plantar response on the right was extension.
Extra- and transcranial duplex sonography indicated (a) a 50%
stenosis of the left internal carotid artery, (b) obliteration of the ori-
gin and the intracranial portion of the right vertebral artery with low
flow signals in the atlanto-occipital portion, and (c) stenosis of the
basilar artery.
Cranial and cervical MRI showed a hyperintense signal in the
right cerebellar hemisphere, the medulla and the right upper cervical
cord on T2 and DWI techniques. The diffusion-weighted imaging
technique revealed a hyperintense signal in the right dorsolateral
medulla oblongata and upper cervical spinal cord, which suggested a
new infarction in the territory of the right posterior inferior cerebellar
artery and the right posterior spinal artery (fig. 1a). The T2-weighted
images showed an additional old left hemispheric cerebellar lesion in
the territory of the left posterior inferior cerebellar artery; there were
no ischemic cortical lesions (images not shown).
During 4 days, the paresis of the right side increased and addi-
tional paresis and paresthesia of the left side developed, resulting in
the neurological findings of flaccid tetraplegia and global anesthesia.
A second MRI at this time, 4 days later than the first MRI, showed
144 Cerebrovasc Dis 2003;15:143–147 Reich/Müller-Schunk/Liebetrau/Scheuerer/
Brückmann/Hamann
Fig. 1. a Cranial, axial, diffusion-weighted MR images showing a
hyperintense lesion (TR = 1,500 ms, TE = 137 ms, FOV = 230 !
230, matrix size = 96 ! 128, b = 1,000 T) in the right cerebellar
hemisphere (*) and in the right dorsolateral medulla oblongata (→).
b Spinal, axial, diffusion-weighted MR images (TR = 1,500 ms, TE =
137 ms, FOV = 230 ! 230, matrix size = 96 ! 128, b = 1,000 T) at
C1/C2 showing an additional bilateral hyperintense lesion in the dor-
solateral spinal cervical cord (→). Right cerebellar hemisphere below
the hyperintense lesion (*).
Fig. 2. a Digital subtraction angiography of the right vertebral artery:
proximal subtotal stenosis of the right vertebral artery (→) in the V1
segment. Right A. subclavia (*). b Digital subtraction angiography of
the right vertebral artery: after passing the proximal stenosis in the
V1 segment, multiple stenotic lesions in the V3 and V4 segment are
evident (→). Occlusion of the PICA and the basilar artery (*). c Dig-
ital subtraction angiography of the left vertebral artery: irregular
plaques in the V4 segment and the basilar artery without stenotic
character.
that in the diffusion-weighted imaging technique, the hyperintense
signal in the right dorsolateral upper cervical spinal cord extended to
the left dorsolateral upper cervical spinal cord (fig. 1b).
Angiography showed several subtotal stenoses of the right verte-
bral artery (proximal and in the atlanto-occipital course) and an
occlusion of the intracranial part. The right posterior inferior cerebel-
lar artery could not be visualized (fig. 2a, b). The left vertebral artery
and the basilar artery showed several irregular plaques (fig. 2c).
A combined cerebellar and spinal stroke due to impairment of the
vertebral blood circulation as a result of multiple subtotal stenoses
was diagnosed. The bilateral extension of the cervical infarction was
attributed to a predominance of the right posterior spinal artery for
the blood supply of the spinal cord and insufficient collateral blood
flow.
The patient was treated with intravenous heparin. Her blood
pressure was kept at a constantly elevated level, and the blood sugar
was optimally managed. Nevertheless, the clinical course of the
patient deteriorated. After developing an occlusive hydrocephalus,
she died from central cardiorespiratory arrest.
Posterior Spinal Artery Stroke Cerebrovasc Dis 2003;15:143–147 145
Discussion
Spinal stroke accounts for about 1.2% of all stroke
events. Most of the reported cases occur in the territory of
the anterior spinal artery. There have been single observa-
tions of combined vertebrobasilar and spinal stroke. Uni-
lateral ischemic lesions in the territory of the posterior
spinal artery are rare [1–3].
Spinal stroke is mainly due to an interference in the
circulation of the cord, which is secondary to a general-
ized or localized reduction of blood flow. Sites of disease
or obstruction leading to spinal ischemia can include the
aorta, vertebral arteries, intercostal and lumbar arteries,
radicular tributary arteries, anterior and posterior spinal
arteries, small spinal vessels, and veins [1]. Although the
causes of spinal stroke are multiple and complex (acute
hypotension, diabetes, vasculitis, syphilitic arteritis, bac-
terial endocarditis, atrial myxoma, mitral valve disease,
cholesterol embolus, vertebral artery dissection and fibro-
cartilaginous embolus), the most relevant etiology is cur-
rently cardiovascular surgery for aortic aneurysm [1].
Risk factors for spinal stroke include the main cardio-
vascular risk factors (hypertension, hypercholesterolemia,
diabetes mellitus, nicotine abuse), bilateral stenoses or
occlusion, especially of the intracranial part of the verte-
bral arteries, advanced age, and a previous history of cere-
bral stroke [1, 4].
Two intrinsic systems supply blood to the spinal cord
(fig. 3). The first system is a posterolateral and pial plexus
formed primarily by the two posterior spinal arteries.
These arteries originate either directly from the vertebral
arteries, or indirectly from the posteroinferior cerebellar
146 Cerebrovasc Dis 2003;15:143–147 Reich/Müller-Schunk/Liebetrau/Scheuerer/
Brückmann/Hamann
Fig. 3. Pattern of arterial supply in the human cervical cord. The centrifugal arterial system from the A. spinalis
anterior (B) supplies mainly the central area; the centripetal arterial system from the Aa. spinales posteriores (A)
supplies mainly the peripheral white matter and the posterior portion of the posterior gray matter. Adapted from
Benavente and Barnett [1].
arteries, and run longitudinally along the posterolateral
sulci of the cord [1, 5–7]. The anatomy of the posterior
spinal arteries varies greatly, sometimes one artery even
moves across to supply both sides of the spinal cord [1, 8,
9]. The pial plexus is mainly fed by the posterior arteries;
the anterior spinal artery and branches from radicular
arteries contribute to this supply to various degrees. This
system has a centripetal flow direction on the axial spinal
cord level and supplies virtually all of the white matter
and the tips of the posterior horns [5, 6, 8]. The second
system is formed by numerous alternating central arteries
that arise from the anterior spinal artery, run horizontally
in the central sulcus, and turn either to the right or to the
left. This system shows a centrifugal flow direction on the
axial spinal cord level and usually supplies the central
gray matter and an adjacent mantle of central white mat-
ter, which includes parts of the corticospinal tracts [4–6].
Several authors [4–7] have described watershed areas
of the two systems. Their different findings bear witness
to the great interindividual variability of the territories
attributed to the centripetal and centrifugal systems.
Unlike the anterior spinal artery, posterior spinal arter-
ies do not supply an area within clear-cut boundaries; they
profit from the extensive and complex anastomotic net-
work. Thus, infarctions in their territory are much less
common and clinical presentation is highly variable [8, 9].
The classic posterior spinal artery syndrome is character-
ized by involvement of the posterior columns and mani-
fested by paresthesia, disturbances in deep sensibility,
and impaired sensitivity to touch in the territories subja-
cent to the lesion [8]. The paresis observed in our patient
is not one of the typical symptoms of posterior spinal isch-
emia. Involvement of both upper and lower limbs sug-
gests that the lesion is above the C3 level, usually thought
to be within the territory of the anterior spinal artery. We
suggest that the blood supply of the spinal cord in our
patient was dominated by the centrifugal system. Addi-
tional, atypical symptoms like paresis could result from
this variant of blood supply. The multiple hemodynami-
cally relevant stenosis of up to 90% of the right vertebral
artery and the limited collateral blood flow due to severe
macropathologic lesions of the left vertebral artery played
a crucial role in the development of combined cerebellar
and spinal stroke in our patient, causing ischemia of the
right PICA and the right posterior spinal artery.
MRI scan shows that infarction of the posterior spinal
arteries can induce lesions of the posterior third of the
spinal cord, including the most superficial part of the pos-
terior funiculus, the bases of the posterior horn, and the
most posterior part of the lateral funiculus [3]. Only one
case of unilateral posterolateral cervical cord infarction
has been documented by MRI so far [10]. To the best of
our knowledge, ours is the first case of combined cerebel-
lar and bilateral cervical posterior spinal artery stroke to
be visualized on MRI.
Posterior Spinal Artery Stroke Cerebrovasc Dis 2003;15:143–147 147
References
1 Benavente O, Barnett HJM: Spinal cord isch-
emia; in Barnett HJM, Mohr JP, Stein BA, Yat-
su FH (eds): Stroke. New York, Churchill Liv-
ingstone, 1998, pp 751–765.
2 Strupp M, Brückmann H, Hamann GF, Brü-
ning R, Brandt T: Simultaneous brachial diple-
gia and rotational vertigo due to combined spi-
nal anterior and vertebrobasilar embolism. Eur
Neurol 2000;43:240–242.
3 Gutowski NJ, Murphy RP, Beale DJ: Unilater-
al upper cervical posterior spinal artery syn-
drome following sneezing. J Neurol Neurosurg
Psychiatry 1992;55:841–843.
4 Mawad ME, Rivera V, Crawford S, Ramirez A,
Breitbach W: Spinal cord ischemia after resec-
tion of thoracoabdominal aortic aneurysms:
MR findings in 24 patients. AJNR 1990;11:
987–991.
5 Turnbull IM: Blood supply of the spinal cord:
Normal and pathological findings. Clin Neuro-
surg 1973;20:56–84.
6 Pullicino P: Bilateral distal upper limb amyo-
trophy and watershed infarcts from vertebral
dissection. Stroke 1994;25:1870–1872.
7 Gillian L: The arterial blood supply of the
human spinal cord. J Comp Neurol 1958;110:
75–103.
8 Tator CH, Koyanagi I: Vascular mechanisms
in the pathophysiology of human spinal cord
injury. J Neurosurg 1997;86:483–492.
9 Lazorthes G: Pathology, classification and clin-
ical aspects of vascular diseases of the spinal
cord; in Viken PJ, Bruyn GW (eds): Handbook
of Clinical Neurology. Amsterdam, Elsevier,
1972, vol 12, pp 492–506.
10 Kaneki M, Inoue K, Shimizu T, Mannen T:
Infarction of the unilateral posterior horn and
lateral column of the spinal cord with sparing
of posterior columns: Demonstration by MRI.
J Neurol Neurosurg Psychiatry 1989;57:629–
631.


Combined cerebellar and bilateral cervical posterior spinal artery stroke demonstrated on MRI

Open Access LMU ( Ludwig-Maximilians-Univ. München)

Case ReportCerebrovasc Dis 2003;15:143–147DOI: 10.1159/000067143Combined Cerebellar and BilateralCervical Posterior Spinal Artery StrokeDemonstrated on MRIP. Reicha S. Müller-Schunkb M. Liebetraua W. Scheuerera H. BrückmannbG.F. HamannaDepartments of aNeurology and bNeuroradiology, Klinikum der LMU München, Grosshadern, Munich, GermanyReceived: October 10, 2001Accepted: June 21, 2002G.F. Hamann, MDDepartment of Neurology, Klinikum der LMU MünchenStandort Grosshadern, Marchioninistrasse 15D–81377 Munich (Germany)Tel. +49 89 70953670, E-Mail hamann@brain.nefo.uni-muenchen.deABCFax + 41 61 306 12 34E-Mail karger@karger.chwww.karger.com© 2003 S. Karger AG, Basel1015–9770/03/0152–0143$19.50/0Accessible online at:www.karger.com/cedThe authors wish to thank Mrs J. Benson for editing the Englishtext.Key WordsSpinal cord stroke W Posterior spinal artery W Vertebralartery stenosis W MRI, diffusion-weightedAbstractCombined cerebellar and spinal ischemic stroke is a rare,critical condition. We report a patient with combined cer-ebellar and bilateral posterolateral cervical spinal cordinfarction due to bilateral stenosis of the vertebral arter-ies. MRI is the method of choice for imaging this condi-tion; diffusion-weighted imaging of the spinal cord givesreliable results.Case ReportA 64-year-old woman with a history of hypertension, hypercho-lesterolemia and insulin-dependent diabetes mellitus was admittedto the hospital after sudden onset of vertigo, nausea, vomiting andelevated blood pressure. Cranial CT scan showed hypodensity of theright cerebellar hemisphere within the territory of the right posteriorinferior cerebellar artery. Seven days later, the patient noted pares-thesia of her right arm, followed by weakness of her right arm andleg.The neurological examination showed (a) a cerebellar hemispheresyndrome with rotatory vertigo, nausea, occipital and nuchal head-ache, symmetrical and horizontal gaze-evoked nystagmus, saccadicsmooth pursuit in all directions, dysarthria, ataxia and dysmetria ofthe right side, as well as (b) brainstem involvement with perioralhypesthesia. In addition, paresis of the right upper and lower limbs(3/5) without facial involvement and paresthesia of the right armwere observed. The muscle stretch reflexes on the right side wereincreased, and the plantar response on the right was extension.Extra- and transcranial duplex sonography indicated (a) a 50%stenosis of the left internal carotid artery, (b) obliteration of the ori-gin and the intracranial portion of the right vertebral artery with lowflow signals in the atlanto-occipital portion, and (c) stenosis of thebasilar artery.Cranial and cervical MRI showed a hyperintense signal in theright cerebellar hemisphere, the medulla and the right upper cervicalcord on T2 and DWI techniques. The diffusion-weighted imagingtechnique revealed a hyperintense signal in the right dorsolateralmedulla oblongata and upper cervical spinal cord, which suggested anew infarction in the territory of the right posterior inferior cerebellarartery and the right posterior spinal artery (fig. 1a). The T2-weightedimages showed an additional old left hemispheric cerebellar lesion inthe territory of the left posterior inferior cerebellar artery; there wereno ischemic cortical lesions (images not shown).During 4 days, the paresis of the right side increased and addi-tional paresis and paresthesia of the left side developed, resulting inthe neurological findings of flaccid tetraplegia and global anesthesia.A second MRI at this time, 4 days later than the first MRI, showed144 Cerebrovasc Dis 2003;15:143–147 Reich/Müller-Schunk/Liebetrau/Scheuerer/Brückmann/HamannFig. 1. a Cranial, axial, diffusion-weighted MR images showing ahyperintense lesion (TR = 1,500 ms, TE = 137 ms, FOV = 230 !230, matrix size = 96 ! 128, b = 1,000 T) in the right cerebellarhemisphere (*) and in the right dorsolateral medulla oblongata (→).b Spinal, axial, diffusion-weighted MR images (TR = 1,500 ms, TE =137 ms, FOV = 230 ! 230, matrix size = 96 ! 128, b = 1,000 T) atC1/C2 showing an additional bilateral hyperintense lesion in the dor-solateral spinal cervical cord (→). Right cerebellar hemisphere belowthe hyperintense lesion (*).Fig. 2. a Digital subtraction angiography of the right vertebral artery:proximal subtotal stenosis of the right vertebral artery (→) in the V1segment. Right A. subclavia (*). b Digital subtraction angiography ofthe right vertebral artery: after passing the proximal stenosis in theV1 segment, multiple stenotic lesions in the V3 and V4 segment areevident (→). Occlusion of the PICA and the basilar artery (*). c Dig-ital subtraction angiography of the left vertebral artery: irregularplaques in the V4 segment and the basilar artery without stenoticcharacter.that in the diffusion-weighted imaging technique, the hyperintensesignal in the right dorsolateral upper cervical spinal cord extended tothe left dorsolateral upper cervical spinal cord (fig. 1b).Angiography showed several subtotal stenoses of the right verte-bral artery (proximal and in the atlanto-occipital course) and anocclusion of the intracranial part. The right posterior inferior cerebel-lar artery could not be visualized (fig. 2a, b). The left vertebral arteryand the basilar artery showed several irregular plaques (fig. 2c).A combined cerebellar and spinal stroke due to impairment of thevertebral blood circulation as a result of multiple subtotal stenoseswas diagnosed. The bilateral extension of the cervical infarction wasattributed to a predominance of the right posterior spinal artery forthe blood supply of the spinal cord and insufficient collateral bloodflow.The patient was treated with intravenous heparin. Her bloodpressure was kept at a constantly elevated level, and the blood sugarwas optimally managed. Nevertheless, the clinical course of thepatient deteriorated. After developing an occlusive hydrocephalus,she died from central cardiorespiratory arrest.Posterior Spinal Artery Stroke Cerebrovasc Dis 2003;15:143–147 145DiscussionSpinal stroke accounts for about 1.2% of all strokeevents. Most of the reported cases occur in the territory ofthe anterior spinal artery. There have been single observa-tions of combined vertebrobasilar and spinal stroke. Uni-lateral ischemic lesions in the territory of the posteriorspinal artery are rare [1–3].Spinal stroke is mainly due to an interference in thecirculation of the cord, which is secondary to a general-ized or localized reduction of blood flow. Sites of diseaseor obstruction leading to spinal ischemia can include theaorta, vertebral arteries, intercostal and lumbar arteries,radicular tributary arteries, anterior and posterior spinalarteries, small spinal vessels, and veins [1]. Although thecauses of spinal stroke are multiple and complex (acutehypotension, diabetes, vasculitis, syphilitic arteritis, bac-terial endocarditis, atrial myxoma, mitral valve disease,cholesterol embolus, vertebral artery dissection and fibro-cartilaginous embolus), the most relevant etiology is cur-rently cardiovascular surgery for aortic aneurysm [1].Risk factors for spinal stroke include the main cardio-vascular risk factors (hypertension, hypercholesterolemia,diabetes mellitus, nicotine abuse), bilateral stenoses orocclusion, especially of the intracranial part of the verte-bral arteries, advanced age, and a previous history of cere-bral stroke [1, 4].Two intrinsic systems supply blood to the spinal cord(fig. 3). The first system is a posterolateral and pial plexusformed primarily by the two posterior spinal arteries.These arteries originate either directly from the vertebralarteries, or indirectly from the posteroinferior cerebellar146 Cerebrovasc Dis 2003;15:143–147 Reich/Müller-Schunk/Liebetrau/Scheuerer/Brückmann/HamannFig. 3. Pattern of arterial supply in the human cervical cord. The centrifugal arterial system from the A. spinalisanterior (B) supplies mainly the central area; the centripetal arterial system from the Aa. spinales posteriores (A)supplies mainly the peripheral white matter and the posterior portion of the posterior gray matter. Adapted fromBenavente and Barnett [1].arteries, and run longitudinally along the posterolateralsulci of the cord [1, 5–7]. The anatomy of the posteriorspinal arteries varies greatly, sometimes one artery evenmoves across to supply both sides of the spinal cord [1, 8,9]. The pial plexus is mainly fed by the posterior arteries;the anterior spinal artery and branches from radiculararteries contribute to this supply to various degrees. Thissystem has a centripetal flow direction on the axial spinalcord level and supplies virtually all of the white matterand the tips of the posterior horns [5, 6, 8]. The secondsystem is formed by numerous alternating central arteriesthat arise from the anterior spinal artery, run horizontallyin the central sulcus, and turn either to the right or to theleft. This system shows a centrifugal flow direction on theaxial spinal cord level and usually supplies the centralgray matter and an adjacent mantle of central white mat-ter, which includes parts of the corticospinal tracts [4–6].Several authors [4–7] have described watershed areasof the two systems. Their different findings bear witnessto the great interindividual variability of the territoriesattributed to the centripetal and centrifugal systems.Unlike the anterior spinal artery, posterior spinal arter-ies do not supply an area within clear-cut boundaries; theyprofit from the extensive and complex anastomotic net-work. Thus, infarctions in their territory are much lesscommon and clinical presentation is highly variable [8, 9].The classic posterior spinal artery syndrome is character-ized by involvement of the posterior columns and mani-fested by paresthesia, disturbances in deep sensibility,and impaired sensitivity to touch in the territories subja-cent to the lesion [8]. The paresis observed in our patientis not one of the typical symptoms of posterior spinal isch-emia. Involvement of both upper and lower limbs sug-gests that the lesion is above the C3 level, usually thoughtto be within the territory of the anterior spinal artery. Wesuggest that the blood supply of the spinal cord in ourpatient was dominated by the centrifugal system. Addi-tional, atypical symptoms like paresis could result fromthis variant of blood supply. The multiple hemodynami-cally relevant stenosis of up to 90% of the right vertebralartery and the limited collateral blood flow due to severemacropathologic lesions of the left vertebral artery playeda crucial role in the development of combined cerebellarand spinal stroke in our patient, causing ischemia of theright PICA and the right posterior spinal artery.MRI scan shows that infarction of the posterior spinalarteries can induce lesions of the posterior third of thespinal cord, including the most superficial part of the pos-terior funiculus, the bases of the posterior horn, and themost posterior part of the lateral funiculus [3]. Only onecase of unilateral posterolateral cervical cord infarctionhas been documented by MRI so far [10]. To the best ofour knowledge, ours is the first case of combined cerebel-lar and bilateral cervical posterior spinal artery stroke tobe visualized on MRI.Posterior Spinal Artery Stroke Cerebrovasc Dis 2003;15:143–147 147References1 Benavente O, Barnett HJM: Spinal cord isch-emia; in Barnett HJM, Mohr JP, Stein BA, Yat-su FH (eds): Stroke. New York, Churchill Liv-ingstone, 1998, pp 751–765.2 Strupp M, Brückmann H, Hamann GF, Brü-ning R, Brandt T: Simultaneous brachial diple-gia and rotational vertigo due to combined spi-nal anterior and vertebrobasilar embolism. EurNeurol 2000;43:240–242.3 Gutowski NJ, Murphy RP, Beale DJ: Unilater-al upper cervical posterior spinal artery syn-drome following sneezing. J Neurol NeurosurgPsychiatry 1992;55:841–843.4 Mawad ME, Rivera V, Crawford S, Ramirez A,Breitbach W: Spinal cord ischemia after resec-tion of thoracoabdominal aortic aneurysms:MR findings in 24 patients. AJNR 1990;11:987–991.5 Turnbull IM: Blood supply of the spinal cord:Normal and pathological findings. Clin Neuro-surg 1973;20:56–84.6 Pullicino P: Bilateral distal upper limb amyo-trophy and watershed infarcts from vertebraldissection. Stroke 1994;25:1870–1872.7 Gillian L: The arterial blood supply of thehuman spinal cord. J Comp Neurol 1958;110:75–103.8 Tator CH, Koyanagi I: Vascular mechanismsin the pathophysiology of human spinal cordinjury. J Neurosurg 1997;86:483–492.9 Lazorthes G: Pathology, classification and clin-ical aspects of vascular diseases of the spinalcord; in Viken PJ, Bruyn GW (eds): Handbookof Clinical Neurology. Amsterdam, Elsevier,1972, vol 12, pp 492–506.10 Kaneki M, Inoue K, Shimizu T, Mannen T:Infarction of the unilateral posterior horn andlateral column of the spinal cord with sparingof posterior columns: Demonstration by MRI.J Neurol Neurosurg Psychiatry 1989;57:629–631.

Bilateral distal upper limb amyotrophy and watershed infarcts from vertebral dissection. Stroke

Blood supply of the spinal cord: Normal and pathological findings. Clin Neurosurg

classification and clinical aspects of vascular diseases of the spinal cord;

DJ: Unilateral upper cervical posterior spinal artery syndrome following sneezing.

HJM: Spinal cord ischemia; in Barnett HJM, Mohr JP,

I: Vascular mechanisms in the pathophysiology of human spinal cord injury.

Infarction of the unilateral posterior horn and lateral column of the spinal cord with sparing of posterior columns: Demonstration by MRI.

Simultaneous brachial diplegia and rotational vertigo due to combined spinal anterior and vertebrobasilar embolism.

The arterial blood supply of the human spinal cord.

W: Spinal cord ischemia after resection of thoracoabdominal aortic aneurysms: MR findings in 24 patients.

P. Reich

S. Müller-Schunk

M. Liebetrau

W. Scheuerer

H. Brückmann

G.F. Hamann

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Combined Cerebellar and Bilateral Cervical Posterior Spinal Artery Stroke Demonstrated on MRI

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Combined cerebellar and bilateral cervical posterior spinal artery stroke demonstrated on MRI

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