Teaching NeuroImages: Sulcal artery syndrome: A hemicord infarct presenting with incomplete Brown-Sequard syndrome.

A 59-year-old man with a history of smoking presented with acute right hemiparesis, pain, and temperature loss on the left below T4 and impaired left-sided abdominal reflexes. Proprioception and vibration were normal. MRI (day 3) showed a short segment of T2 hyperintensity at the right half of C5 spinal cord (figure 1); diffusion-weighted MRI (day 5) demonstrated restricted diffusion (figure 2), confirming hemicord infarct. Sulcal artery occlusion presents with incomplete Brown-Sequard syndrome and is uncommon, unlike the more common anterior spinal artery syndrome.1 It preferentially involves the cervical cord.2 With physiotherapy, aspirin, and statins, this patient recovered well.