Abstract Details

Title “Crescent Moon” Sign in Complete Brown-Sequard Syndrome Caused by Spinal Cord Infarction

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-006

Objective To report a novel “Crescent Moon” sign in magnetic resonance imaging (MRI) in a rare case of complete Brown-Sequard Syndrome (BSS) caused by Spinal Cord Infarction (SCI).

Background SCI is uncommon and typically injures the anterior spinal artery (ASA) territory; posterior spinal artery (PSA) territory involvement is very rare. In the cervical spinal cord, the ASA branches off the vertebral arteries; the PSA from the posterior inferior cerebellar or vertebral arteries. SCI rarely causes BSS. When provoked, it manifests with a partial presentation consisting of ipsilateral hemiparesis, contralateral spinothalamic deficit, and sparing proprioception. In such cases, the pathogenesis is sulcal artery occlusion that spares the posterior column. We describe a novel “Crescent Moon” sign in MRI associated with complete BSS in SCI after vertebral artery occlusion (VAO). The likely mechanism was right ipsilateral ASA and PSA territory ischemia secondary to VAO.

Design/Methods A 74-year-old male with a history of smoking, hypertension, hyperlipidemia, head and neck radiation after mouth and pharyngeal cancer developed sudden onset right-sided weakness and left-sided numbness. Examination showed right-sided hemiplegia and proprioception loss, with left-sided temperature and pain sensation loss, compatible with BSS localizing to the right hemicord at the C2 level.

Results Plain and perfusion CT-Brain were unremarkable. Head and neck CTA revealed right VAO. Axial MRI view of the cervical spine showed a “Crescent Moon” shaped area of restricted diffusion in DWI and ADC sequences consistent with C1-C3 right hemicord acute ischemic infarct. After stroke work-up, it was determined the etiology was VAO secondary to progressive stenosis triggered by radiotherapy. The patient was acutely treated with mean arterial pressure augmentation, followed by dual antiplatelet, statins, and physical therapy.

Conclusions The “Crescent Moon” MRI pattern is associated with complete Brown-Sequard syndrome in SCI. To our knowledge, this sign has not been previously reported in the literature.

Authors/Disclosures
Daniel Moreno-Zambrano, MD PRESENTER	Dr. Moreno-Zambrano has nothing to disclose.
Ricardo E. Martinez, MD	Dr. Martinez has nothing to disclose.
Rafael Martinez	No disclosure on file
Roberto E. Sanchez, MD (Roberto E Sanchez MD PA)	Dr. Sanchez has nothing to disclose.
Ariol Labrada, MD (Ariol Labrada MD PA)	Dr. Labrada has nothing to disclose.

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