目的：汇报椎动脉夹层致双侧颈髓梗死合并意义未明单克隆免疫球蛋白血症（monoclonal gammopathy of undetermined significance，MGUS）1例。方法：收集2021年1月就诊于我院神经内科的1例脊髓梗死 患者的临床资料，完善血液生化检查、颈髓MRI、血管成像、骨髓活检等，并结合文献进行回顾性分析。结 果：1例68岁男性，主诉”右侧肢体无力”入院。患者骑摩托车急转弯后突发颈部放射痛，随后逐渐出现右侧 肢体瘫痪、左侧肢体麻木无力及尿潴留。神经系统查体符合脊髓前动脉综合征。患者入院查D二聚体异常 升高，伴左下肢肌间静脉血栓、右肺下叶肺动脉栓塞，提示患者存在高凝状态。脊髓MRI平扫及扩散加权成 像证实C2～C4节段不对称性梗死。脑血管造影检查提示右侧椎动脉C3椎体层面闭塞，闭塞近端呈多发狭 窄；高分辨MRI发现右侧椎动脉V2～V4段存在壁内血肿，符合椎动脉夹层表现。免疫固定电泳发现κ型IgG 单克隆免疫球蛋白条带，骨髓穿刺活检显示单克隆浆细胞比例增高（3.8%），符合MGUS诊断。对该患者给 予利伐沙班抗凝治疗和康复治疗，血液科建议定期随访。文献检索到椎动脉夹层所致的脊髓梗死60例，对 其中34例孤立性脊髓梗死患者的临床特征进行分析发现，70.6%的患者为男性，38.2%的患者存在按摩、转 颈等诱因，94.1%的患者起病时有颈部疼痛及肢体乏力等症状，82.4%的患者为单侧椎动脉夹层（其中单侧脊 髓梗死占46.4%，双侧脊髓梗死占42.9%），94.1%的患者接受了抗凝或双重抗血小板治疗。检索到恶性肿瘤 相关的脊髓梗死61例，其中33例为血液系统恶性肿瘤，明确考虑致病机制为肿瘤相关高凝状态的脊髓梗死 有4例。1例考虑病因为椎动脉夹层的颈髓梗死患者，同时存在M蛋白血症，考虑合并MGUS。结论：当孤 立性脊髓梗死作为椎动脉夹层的非典型临床表现出现时，系统性筛查导致脊髓梗死的其他少见病因是必要 的，需警惕恶性增殖性疾病尤其是血液系统疾病导致的高凝状态。

To report a case of bilateral cervical spinal cord infarction caused by vertebral artery dissection complicated with monoclonal gammopathy of undetermined significance (MGUS). Methods: Clinical data were collected from a patient with spinal cord infarction who was admitted to the neurology department of our hospital in January 2021. Blood biochemical tests, cervical spinal cord MRI, vascular imaging, bone marrow biopsy, and other examinations were performed, and a retrospective analysis was conducted in conjunction with relevant literature. Results: A 68-year-old male patient was admitted with the chief complaint of "right limb weakness." The patient experienced sudden radiating neck pain after making a sharp turn on a motorcycle, followed by gradual onset of right limb paralysis, left limb numbness and weakness, and urinary retention. Neurological examination findings were consistent with spinal cord anterior artery syndrome. Upon admission, the patient had an abnormally elevated D-dimer level, accompanied by intermuscular venous thrombosis in the left lower limb and pulmonary embolism in the right lower lobe of the lung, indicating a hypercoagulable state. Plain MRI and diffusion-weighted imaging of the spinal cord confirmed asymmetric infarction at the C2～C4 levels. Cerebral angiography revealed occlusion of the right vertebral artery at the level of the C3 vertebral body, with multiple stenoses proximal to the occlusion. High-resolution MRI revealed an intramural hematoma in the V2～V4 segments of the right vertebral artery, consistent with vertebral artery dissection. Immunofixation electrophoresis revealed a κ-type IgG monoclonal immunoglobulin band, and bone marrow biopsy showed an increased proportion of monoclonal plasma cells (3.8%), consistent with the diagnosis of MGUS. The patient was treated with rivaroxaban for anticoagulation and rehabilitation therapy, and the hematology department recommended regular follow-up. A literature search identified 60 cases of spinal cord infarction caused by vertebral artery dissection. Analysis of the clinical characteristics of 34 patients with isolated spinal cord infarction revealed that 70.6% were male, 38.2% had triggers such as massage or neck rotation, 94.1% presented with neck pain and limb weakness at onset, 82.4% had unilateral vertebral artery dissection (with unilateral spinal cord infarction accounting for 46.4% and bilateral spinal cord infarction accounting for 42.9% ), and 94.1% received anticoagulation or dual antiplatelet therapy. A literature search identified 61 cases of spinal cord infarction associated with malignancies, of which 33 were hematologic malignancies. Four cases were clearly considered to be caused by a hypercoagulable state associated with the malignancy. One patient with cervical spinal cord infarction considered to be caused by vertebral artery dissection also had M proteinemia and was considered to have concurrent MGUS. Conclusion: When isolated spinal cord infarction presents as an atypical clinical manifestation of vertebral artery dissection, it is necessary to systematically screen for other rare causes of spinal cord infarction. Attention should be paid to the hypercoagulable state caused by malignant proliferative diseases, especially hematologic disorders.