A man presents with sudden flaccid paraplegia and loss of pain and temperature sensation below the umbilicus, but vibration sense and joint position sense are intact in both legs. Which artery is most likely occluded?

• A Artery of Adamkiewicz supplying the anterior spinal artery ✓
• B Posterior spinal arteries
• C Left radicular artery at T5
• D Posterolateral spinal artery

Explanation

Anterior spinal artery infarction spares the dorsal columns because they are supplied by the paired posterior spinal arteries, giving the classic dissociation of preserved vibration and proprioception with lost motor and spinothalamic function. The anterior spinal artery is reinforced at the lower thoracic or upper lumbar level by the artery of Adamkiewicz, whose territory explains a T10 sensory level (umbilicus). Posterior spinal artery occlusion would spare motor power, contradicting the paraplegia here.

Reference: Gray's Anatomy, 42nd ed.

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Written and medically reviewed by the StethoPrep medical team.