Abstract
A 72-year-old male was admitted with right neck pain and hemiplegia. Mild right facial palsy and Horner’s syndrome were noted. Pain and heat sensation were disturbed in the face and the left hemibody. Touch and deep sensation were diminished on the right side. The right soft palate, sternocleidomastoid muscle, and trapezius muscle exhibited paresis. Bilateral Babinski reflexes were positive. MR images revealed a dorsolateral infarction of the right medulla and a lateral infarction of the upper spinal cord. A small cerebellar infarction was noted. Cerebral angiography showed occlusion of the proximal portion of the bilateral vertebral arteries, and the branches of the thyrocervical trunks worked as collateral circulation. The mechanism of this infarction was suspected to be artery-to-artery embolism. Three months later, the patient was able to walk using a cane. After four years, the patient was admitted with severe paraplegia. Cerebral MRI revealed a brain infarction in the medial right precentral gyrus. No other new lesions were observed. The patient again recovered and was able to walk using a cane, but not as well as before. One possible mechanism for this pattern of recovery is reorganization of the right motor cortex such that the non-affected medial part of the right precentral gyrus acquired the ability to control both legs. When the area was damaged by the second attack, paraplegia resulted. This is the first report of tandem infarctions of unilateral spinal cord and cerebellum resulting in paraplegia.
