Tokumoto Kazuki, Ueda Nobuhiko
Department of Neurology, Ishikiriseiki Hospital.
Rinsho Shinkeigaku. 2014;54(2):151-7. doi: 10.5692/clinicalneurol.54.151.
A-68-year-old man experienced nuchal pain and bilateral shoulder weakness that occurred suddenly after he performed a golf swing. He was conscious. His cranial nerves were normal, but bilateral deltoid and biceps muscle strengths weakened. Magnetic resonance image (MRI) showed no brain stem infarctions or cervical epidural hematoma. We tentatively diagnosed him with concussion of the spinal cord because of mild recovery of his bilateral upper limb weakness after several hours; he was later discharged. The next day, he suddenly developed serious tetraplegia and was admitted to the emergency department. His breathing was controlled by a respirator as he had expectoration difficulty and respiratory muscle paralysis. A lesion in the cervical cord became apparent on MRI; the right vertebral artery was not detected on magnetic resonance angiography. Cervical MRI showed the intimal flap and a lack of flow void in the right vertebral artery. These findings revealed a right vertebral artery dissection. Cervical cord infarction due to unilateral vertebral artery dissection is rarer than posterior cerebral infarction due to the same pathogenesis; however, some such cases have been reported. We consider the present case to be caused by cervical cord infarction associated with unilateral vertebral artery dissection resulting from golf swing.
一名68岁男性在打完高尔夫挥杆动作后突然出现颈部疼痛和双侧肩部无力。他意识清醒。其颅神经正常，但双侧三角肌和肱二头肌肌力减弱。磁共振成像（MRI）显示无脑干梗死或颈椎硬膜外血肿。由于数小时后其双侧上肢无力稍有恢复，我们初步诊断他为脊髓震荡；随后他出院了。第二天，他突然出现严重的四肢瘫痪并被收入急诊科。由于他咳痰困难且呼吸肌麻痹，其呼吸由呼吸机控制。MRI显示颈椎脊髓有病变；磁共振血管造影未检测到右侧椎动脉。颈椎MRI显示右侧椎动脉有内膜瓣且无血流空洞。这些发现提示右侧椎动脉夹层。因单侧椎动脉夹层导致的颈髓梗死比因相同发病机制导致的大脑后动脉梗死更罕见；然而，已有一些此类病例的报道。我们认为本例是由高尔夫挥杆动作导致的单侧椎动脉夹层伴发颈髓梗死所致。
