Letter to the editor to the article, 'Severe unilateral proprioceptive loss in medullary- rostral spinal cord infarction. A posterior spinal artery syndrome' by Caplan LR and Chang YM
Letter to the editor to the article, 'Severe unilateral proprioceptive loss in medullary- rostral spinal cord infarction. A posterior spinal artery syndrome' by Caplan LR and Chang YM
复制标题
致文章编辑的信，“延髓头端脊髓梗塞导致严重的单侧本体感觉丧失”。
DOI：
10.1016/j.jstrokecerebrovasdis.2022.106620
复制
发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Mori N.
中科院分区：
文献类型：
--
作者：
Mugikura S;Mori N.
编辑：我们怀着极大的兴趣阅读了Caplan和Chang的一份病例报告，该报告报告了两名患者在累及延髓尾侧和头端脊髓的梗塞同侧肢体出现急性严重本体感觉丧失。1患者的症状和体征也常见于延髓外侧梗死。我们完全同意作者的结论，即在两名以延髓外侧梗死为特征的患者中，出现严重的同侧本体感觉丧失表明受累于头端脊髓，这种梗死归因于脊髓后动脉(PSA)的闭塞。事实上，最近的一项对7具身体标本14侧的显微外科解剖研究显示，PSA分支至延髓尾侧和头端脊髓，尽管在对动脉的描述中很少提到此类分支。2在本研究中，3侧来自颅内椎动脉(ICVA)的PSA或11侧来自小脑后下动脉(PICA)的PSA与延髓尾侧相邻。此外，在两侧发现的14个PSA均有分支通向延髓，平均每侧有6个分支。PSA到达下延髓区域，分出升支和降支。升支供应尾侧延髓，而降支沿脊髓尾侧，供应脊髓的后三分之一，包括负责本体感觉功能的部位。2因此，我们认为，这种对PSA的显微外科解剖研究支持这样的结论，即累及延髓尾侧和头端的梗塞同侧肢体的严重本体感觉丧失与PSA闭塞之间存在因果关系。我们对Caplan等人提出的结果很感兴趣。其中1例MR血管成像显示同侧颈内动脉被剥离至梗死灶，另1例同侧颈内动脉无明显狭窄闭塞改变。我们认为，在这些病例中的发现可能表明敏感闭塞病变之间的因果关系。
Dear Editor: We read with great interest a case report by Caplan and Chang that presented two patients who developed acute severe proprioceptive loss in the limbs ipsilateral to infarcts involving the caudal medulla and rostral spinal cord. 1 The patients also had symptoms and signs that were often found in lateral medullary infarctions. We completely agree with the authors’ conclusion that the presence of severe ipsilateral proprioceptive loss in two patients with features of lateral medullary infarction indicates involvement of the rostral spinal cord and that such infarction is attributed to the occlusion of the posterior spinal artery (PSA). Indeed, a recent microsurgical anatomical study of 14 sides of seven cadaveric specimens showed that the PSA branched to the caudal medulla and rostral spinal cord, although such branches to the caudal medulla are rarely mentioned in descriptions of the artery. 2 In this study, the PSA from the intracranial vertebral artery (ICVA) in 3 of 14 sides or the posterior inferior cerebellar artery (PICA) in 11 of 14 sides was adjacent to the caudal medulla. In addition, all 14 PSAs found on both sides had branches going to the medulla, and the average number of branches on each side was six. PSAs reach the region of the lower medulla and bifurcate into ascending and descending branches. The ascending branch supplies the caudal medulla, whereas the descending branch travels caudally along the spinal cord, supplying the posterior third of the spinal cord, including the sites responsible for proprioceptive functions. 2 Therefore, we suppose that such a microsurgical anatomical study of PSA supports the conclusion that a causal relationship exists between the severe proprioceptive loss in the limbs ipsilateral to the infarcts involving the caudal medulla and rostral spinal cord and PSA occlusion. We are interested in the result presented by Caplan et al. that in one of the two cases, MR angiography showed dissection of the ipsilateral ICVA to the infarction and no apparent steno-occlusive change in the ipsilateral ICVA in the remaining case. We suppose that the findings in these cases could indicate the causal relationship between the senoocclusive lesions