Sulcal artery syndrome; a pain predominant presentation

A 41-year-old man with a neonatal history of Erb's palsy presented with severe bilateral gnawing radicular arm pain. A detailed neurological examination detected no abnormality. Imaging revealed right hemi spinal cord T2 hyperintensity together with an occluded left vertebral artery to the V4 segment. The clinical syndromes and mechanisms of spinal cord infarction are discussed. A hypothesis for the lack of sensorimotor signs is put forward.