Spinal cord hemodynamic infarction after vertebral artery endovascular trapping despite preserved flow in the anterior spinal artery

Context: Spinal cord infarction is a rare condition that develops as a result of insufficient vascular perfusion, sometimes related to procedures involving the aorta and vertebral arteries. Findings: We present the case of a 66-year-old woman who developed weakness on all four extremities and thermalgesic sensory deficit following an elective endovascular embolization of an incidentally diagnosed aneurysm in the posterior circulation. The procedure involved the cathetherization of both vertebral arteries, but was unremarkable and the flow into the anterior spinal artery was preserved. Radiological findings highly suggested a spinal cord infarction. She was started on corticosteroids and showed a significant neurological improvement. Clinical relevance: The present case illustrates that spinal cord infarction is a typical – but uncommon – complication that has to be suspected after vertebral artery endovascular procedures. It can result from hypoperfusion of smaller branches that irrigate the cervical spinal cord, and patients can make remarkable recoveries despite severe initial deficits.