Spinal stroke

Spinal Cord Infarction
Spinal Cord Ischaemia

1. Spinal Stroke Ade Wijaya, MD – February 2019

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. Etiology S pontaneous and traumatic uni- or bilateral vertebral artery (VA ) dissection Arteriosclerosis or cardiac embolic occlusion of the VA H ypotension , e.g. due to cardiac failure Drugs F ibrocartilaginous embolism into the radiculomedullar artery V asculitis , e.g . panarteriitis nodosa, antiphospholipid antibody syndrome, neurosyphilis , systemic lupus erythematosus, sickle cell disease V aricella 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, S coliosis 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.

5. 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.

6. 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.

7. 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.

8. 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