case_images: PMC10846348_01
case_images: Neuro-imaging in the acute setting.. a) MRI of the brain (axial DWI) reveals a small (<15mm in diameter) and deep left lacunar infarction (depicted by the black circle).. b) Magnetic resonance angiography (MRA) of the Circle of Willis (anteroposterior view) demonstrates the continuous structure of the Circle of Willis, with no stenosis observed along the basilar artery, middle cerebral arteries, and penetrating arteries.. c) Magnetic resonance angiography (MRA) of the Circle of Willis (infero-superior view) provides a different perspective, confirming the continuity of the Circle of Willis, with no evident stenosis changes observed along the basilar artery, middle cerebral arteries, and penetrating arteries.
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case_images: FIG1
case_images: Initially, CT and magnetic resonance angiography (MRA) of the brain revealed a left lacunar infarct, leading to the provisional diagnosis of a recent left lacunar infarct with right hemiparesis (Figure 1a-1c).
case_images: MRI of the cervical spine in various views.. a) Spinal cord compression with cord changes spanning from C4 to C6, with a more severe level of compression observed at the C4/C5 level (indicated by the black arrow) (sagittal view).. b) Severe central cervical canal stenosis at the C4/C5 level, characterized by complete cerebrospinal fluid effacement and evident cord compression (indicated by the white arrow) (axial view).. c) Moderate central cervical canal stenosis with near-complete cerebrospinal fluid effacement and cord indentation at the C5/C6 level (indicated by the white arrow) (axial view).
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case_images: PMC10846348_01_cureus-0016-00000051789-i02.jpg
case_images: FIG2
case_images: These findings led to the diagnosis of CCS, which encompassed intervertebral disc protrusion, hypertrophy of the ligamentum flavum, and the formation of osteophytes (Figure 2a-2c).
case_images: Computed tomography of the cervical spine.. a) Sagittal view computed tomography of the cervical spine revealing osteophyte formation over the cervical vertebrae, with no evidence of ossification of the posterior longitudinal ligament.. b) Coronal view computed tomography of the cervical spine showing uncovertebral hypertrophy without any observed vertebral fractures, subluxations, or dislocations.
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case_images: FIG3
case_images: This examination aimed to identify the source of spinal canal compression and to facilitate appropriate pre-operative planning (Figure 3a-3b).
case_images: Clinical pictures of intra-operative positioning.. The clinical picture shows the patient lying prone, with the head securely held in place using a Mayfield  Cranial Stabilization System, with pin placement over the sweatband zone. Additionally, the bilateral shoulders are pulled and strapped with an adhesive strap to tense the skin over the operative field.. a) Superior view, b) Side view.
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case_images: FIG4
case_images: In this surgical procedure, the patient, positioned in a prone stance with head stabilization via a Mayfield clamp, underwent general anesthesia (Figure 4a-4b).
case_images: The intraoperative clinical picture demonstrates successful decompression of the spinal cord following laminectomy from C4 to C6, with an intact dura mater and no evidence of cerebrospinal fluid leakage.
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case_images: PMC10846348_01_cureus-0016-00000051789-i05.jpg
case_images: FIG5
case_images: Fortunately, the dura mater remained intact with no observed cerebrospinal fluid (CSF) leakage (Figure 5).
case_images: Post-operative cervical radiographs reveal the accurate trajectory of lateral mass screws, along with the restoration of cervical lordosis and disc height.. a) anteroposterior view, b) lateral view
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case_images: FIG6
case_images: The final reduction was deemed acceptable under intraoperative imaging guidance (Figure 6a-6b).
case_images: The postoperative clinical picture indicates a favorable prognosis, demonstrating the recovery of bilateral upper limb function with the ability to perform a 'thumbs-up' gesture, signifying the restoration of motor power from C7 to T1.
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case_images: FIG7
case_images: One week post-operation, he was discharged, demonstrating the ability to perform bed and wheelchair transfers, stand with assistance, and exhibit good upper limb function (Figure 7).