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AJNR - American Journal of Neuroradiology

Published ahead of print on July 10, 2008
doi: 10.3174/ajnr.A1159

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Cement-Embolic Stroke Associated with Vertebroplasty

F.A. Marden^a and C.M. Putman^b

^a Department of Radiology, Inova Fairfax Hospital, Falls Church, Va
^b Department of Neurosurgery, George Washington University, Washington, DC

View larger version (79K): [in this window] [in a new window]   Fig 1. Fluoroscopic images from the vertebroplasty procedure show a mild spinal compression fracture and PMMA filling the vertebra (A, posterior-anterior; B, lateral). There is a small amount of extrusion into the prevertebral soft tissues on the left (white arrow) and paraspinal veins (black arrows).

View larger version (62K): [in this window] [in a new window]   Fig 2. CTA shows a round focal density in the M1 segment of the left MCA (arrow), consistent with PMMA (A, maximum intensity projection image; B, bone window).

View larger version (69K): [in this window] [in a new window]   Fig 3. Angiography shows a small round embolus with the same radio-opacity as PMMA in the proximal left MCA (arrow), associated with an adjacent arterial occlusion (A, native image; B, digital subtraction angiography).

View larger version (126K): [in this window] [in a new window]   Fig 4. Angiography after the embolus had been advanced distally to the MCA trifurcation (arrow). Flow is restored in the middle and inferior M2 branches. However, the superior M2 branch is occluded.