2. Introduction
Rare; less than 1 % of all strokes
Extensive vascular collateral network
Acute disruption of the spinal cord blood supply resulting in ischemia, infarction
and acute spinal cord dysfunction with related clinical neurological deficits linked
to the blood supply territory of the affected
Romi F, Naess H. Spinal cord infarction in clinical neurology: a review of characteristics and long-term prognosis in comparison to cerebral infarction. European neurology. 2016;76(3-4):95-8.
Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology. 2015 Mar 1;57(3):241-57.
3. Anatomy
Anterior spinal artery (ASA)
Dual posterior spinal arteries (PSA)
Dual posterolateral spinal arteries (PLSA)
The spinal arteries in turn receive their blood supply from different regional arteries:
C1–T3 is supplied by the vertebral arteries
T3–T7 receives a branch from the intercostal arteries
T8 to the medullary conus is supplied by the Adamkiewicz artery and in some cases there is
a medullary conus artery arising from the internal iliac artery
Romi F, Naess H. Spinal cord infarction in clinical neurology: a review of characteristics and long-term prognosis in comparison to cerebral infarction. European neurology. 2016;76(3-4):95-8.
Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology. 2015 Mar 1;57(3):241-57.
4.
5. Etiology
Spontaneous and traumatic uni- or bilateral vertebral
artery (VA) dissection
Arteriosclerosis or cardiac embolic occlusion of the VA
Hypotension, e.g. due to cardiac failure
Drugs
Fibrocartilaginous embolism into the radiculomedullar
artery
Vasculitis, e.g. panarteriitis nodosa, antiphospholipid
antibody syndrome, neurosyphilis, systemic lupus
erythematosus, sickle cell disease
Varicella zoster virus vasculopathies
Cocaine misuse
In the elderly especially, aortic diseases like
arteriosclerosis, aortic dissections and aortic aneurysm
repair
Spinal decompression sickness after diving
Chiropractic manipulation
Diagnostic and therapeutic interventional
blockades of cervical or lumbar nerve roots,
Scoliosis operation of the spine
Complication of intracranial endovascular
intervention
Intravascular malignant lymphomatosis
Subarachnoid haemorrhage
Meningococcal meningitis
“Surfer’s myelopathy”
Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology. 2015 Mar 1;57(3):241-57.
6. Clinical Features
30 to 45 min going along with radicular, e.g. belt-like acute pain representing the
overture of this severe neurological disease
Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology. 2015 Mar 1;57(3):241-57.
7. Differential Diagnosis
Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology. 2015 Mar 1;57(3):241-57.
8. Treatment and Prognosis
Treatment: supportive and treatment of the risk factors
Younger patients and men usually present with more severe spinal cord strokes in the
initial phase
A week after ictus, however, men tend to improve more rapidly than women in terms of
less severe disability scores in relation to their initial neurological deficits
Long-term mortality (9%) in spinal cord infarction patients is associated with higher age,
severity of deficits in the acute phase and peripheral vascular disease
Many spinal cord infarction patients experience significant improvement with time. Up
to half of the patients who were unable to walk 1 week after spinal cord infarction onset
are able to walk on follow-up
Up to 79% of spinal cord infarction patients report chronic pain on follow-up
Romi F, Naess H. Spinal cord infarction in clinical neurology: a review of characteristics and long-term prognosis in comparison to cerebral infarction. European neurology. 2016;76(3-4):95-8.
9. Summary
No well-established effective therapy
Acute onset ( < 4 hours )
Diagnostically challenging
MRI
The occurrence of vertebral body infarction is of particular value for a positive
diagnosis of spinal cord ischemia