Spinal cord infarction and differential diagnosis springerlink. Confirmatory spinal cord infarction sci findings are shown, including vertebral body infarction on short. Spinal cord infarction in the anterior spinal artery territory, which is more frequent than posterior spinal arterial ischemia. She also lost control of bowel and bladder function. Magnetic resonance imaging showed spinal cord infarction affecting c6t3 segments, and severe cervical and lumbar spine degenerative. The american heart association stroke council identified paucity of epidemiological data regarding spinal cord infarction. A somewhat similar case of apparently isolated spinal cord arteritis, fatal in 6 months, was described by feasby et al. Seven of the 10 patients of pelser and van gijn 10 also developed pain, which was not dependent on the severity of motor deficits. Spinal cord infarction with multiple etiologic factors ncbi. Current consensus recommendations are antiplatelet therapy and the symptomatic management of associated complications such as. Clinical features the clinical symptoms are variable.
Therefore, the clinical and radiological presentation of spinal cord infarcts and their short term outcome remain poorly understood. Vongveeranonchai et al spinal cord infarction e205 can exclude cord compression but are unlikely to provide information about sci. However, it is an important differential diagnosis for nonpainful myelopathies such as concussive spinal cord trauma or a lowvolumehighvelocity disc extrusion. If the spinal cord is severed, full recovery is extremely unlikely. As with cerebral infarction, the onset of spinal cord infarction is typically abrupt 1,2. Although several useful studies describing the clinical and radiological features of spinal cord infarction have been published and the characteristics of the presenting syndrome are fairly well known, its risk factors apart from aortic dissection and aortic surgery, area of maximal cord involvement, and. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury. The infarct was cervical in seven patients, thoracic in three, thoracolumbar in 15, and restricted to the conus in three. Infarction of the cervical spinal cord following multilevel. Disruption in blood flow results in local infarction caused by hypoxia and ischemia.
The technique has been shown to be efficacious in relieving the patients symptoms. A spinal stroke is caused by a disruption in the blood supply to the spine. Patients with a spontaneous sci are often misdiagnosed as having transverse myelitis. The aim of the study was to analyze the mr imaging findings and evaluate their correlations with clinical symptoms in ischemic spinal cord lesions. Pain is a frequent disabling feature two months after a spinal cord infarct 10,11. Acute spinal cord infarction sci is uncommon, account ing for 1. Etiologies of completed strokes were diverse and included rupture and surgical repair of aortic aneurysms, aortic dissection, aortic rupture and thrombosis, global ischemia, anterior spinal artery embolism, repair and thrombosis of spinal arteriovenous malformations, hematomyelia, epidural hematoma, cervical osteophytosis, celiac plexus block, systemic lupus erythematosus, coagulopathy, and decompression sickness. Aan members we have changed the login procedure to improve access between and the neurology journals. Acute spinal cord ischemia syndrome represents only 58% of acute myelopathies 4,5 and spinal cord stroke. These four patients had a typical clinical syndrome of acute anterior spinal cord infarct. As illustrated by our patient, the upper thoracic cord is a watershed zone between anterior radicular arteries.
Spinal cord infarction sci following lumbar tf esi is one of the rarest yet most devastating complications, with 5 cases reported in the literature. A populationbased study of the incidence of acute spinal. Spinal cord infarction neurologic disorders msd manual. While spinal cord infarction as observed in this case is rare, it should still be taken into consideration. Lesion patterns and concomitant signs such as vertebral body infarction highly depend on the. Spinal cord infarction with aortic dissection pdf paperity. This study aims to investigate the clinical features and magnetic resonance imaging mri findings in patients with spinal cord infarction sci. Dec 04, 2017 a spinal stroke is caused by a disruption in the blood supply to the spine. Spinal cord infarction during physical exertion due to. May 15, 2019 this study aims to investigate the clinical features and magnetic resonance imaging mri findings in patients with spinal cord infarction sci and neuromyelitis optica spectrum disorders nmosds.
Most studies on spinal cord infarction have been conducted in single centres. The first page of the pdf of this article appears above. Evaluation of a patient with spinal cord infarction after a. Frequently spinal cord infarction is caused by a specific form of arteriosclerosis called atheromatosis, in which a deposit or accumulation of. We report the case of a middleaged patient without obvious risk factors for atherosclerosis who had sci from right vad. The most common clinical presentation of a spinal cord infarction is anterior spinal artery syndrome. The authors present a case of delayedonset spinal cord infarction after repeated tumor excision surgeries of the thoracic spine. Spinal cord infarction is a stroke that occurs either within the arteries that supply the spinal cord or in the spinal cord itself.
Aug 16, 2017 epidural hematoma after epidural anesthesia is a typical nerve complication. Spinal cord infarction usually results from ischemia originating in an extravertebral artery. A practical approach to the diagnosis of spinal cord. Its manifestations are similar, however, and are often abrupt in onset, dramatic in scope, and frequently disabling. Spinal cord infarction is a rare but often devastating disorder caused by a wide array of pathologic states.
After a spinal cord injury, a persons sensory, motor and reflex messages are affected and may not be able to get past the damage in the spinal cord. Three patients experienced transient ischemic attacks. Therefore, the clinical and radiological presentation of. Epidural hematoma after epidural anesthesia is a typical nerve complication. There are no clear guidelines for the treatment of spinal strokes. Occlusive vascular lesions affecting the spinal cord spinal stroke are diagnostic challenges. An otherwise healthy 40yearold man presented with acute rightsided body weakness. Spinal cord infarction has many similarities to cerebral infarction in that the presentation varies depending on the vascular territory, the size of the lesion, cause, and collateral circulation. Spinal cord infarction secondary to fibrocartilaginous embolization fce of spinal vasculature is a rare entity in cats 2022. It can vary in its onset, severity, outcome, and recovery from patient to patient.
In comparison to its cerebral counterpart, the spinal cord infarction has extremely low incidence. If the neurologic manifestations are attributable to a specific spinal cord arterial territory, the. Evaluation of a patient with spinal cord infarction. Differential diagnosis the differential diagnosis of acute spinal cord dysfunction includes several nonischemic causes. As is the case for the more common cerebrovascular accident affecting cerebral circulation, an acute onset is a clue to the diagnosis. Patients with a firsttime diagnosis of spinal cord infarction were categorized as primary or secondary depending upon underlying etiology identified. Reviewing the 3 cases of spinal cord infarction or ischemia associated with pv in the literature, 1 patient also had his symptoms developing after physical effort. The intramedullary vessels were mostly affected, including. Aortic dissection is a possible etiological factor and is usually associated with severe chest or back pain. Spinal cord injury diagnosis and treatment mayo clinic. You can manage this and all other alerts in my account. Spinal cord infarction represents only around 1% of ischaemic strokes.
Spinal cord infarction following epidural and general. The single anterior spinal artery supplies the anterior two thirds of the spinal cord and is most often affected in sci, producing the classic picture of motor findings and dissociated sensory loss. Spinal cord infarction remains the less wellstudied form of acute ischemic stroke. For this view, the dura and arachnoid membranes have been cut longitudinally and retracted pulled aside.
The initial magnetic resonance imaging mri is usually normal and can mimic the presentation of the acute transverse myelitis atm, acute inflammatory demyelinating polyneuropathy, and compressive myelopathies from neoplasm, epidural or subdural hematoma, or abscess. The mri features of spinal cord infarction and aqp4ab positive nmosd can overlap,18 with no significant differences in lesion length, crosssectional area and cord expansion. Importance spinal cord infarction sci is often disabling, and the diagnosis can be challenging without an inciting event eg, aortic surgery. The aim of this report is to describe and discuss the case of a patient. Acute spinal cord infarction sci is an uncommon but clinically important disease with a generally poor prognosis. It is possible that physical exertion acted as a trigger for spinal cord infarction due to the abovementioned mechanisms. In one case series, systemic hypotension was identified as the cause of nonsurgical sci in 11% of the patients. Apr, 2020 spinal cord infarction is a stroke that occurs either within the arteries that supply the spinal cord or in the spinal cord itself. Spinal cord infarction after surgery in a patient in the hyperlordotic position you will receive an email whenever this article is corrected, updated, or cited in the literature. Spinal cord ischemia and infarction occur less frequently than cerebral.
The neurologic presentation of spinal cord infarction is largely defined by the vascular territory involved. Characteristics of spontaneous spinal cord infarction and. Spinal cord infarction sci is a rare type of stroke. Spinal cord infarction following lumbar transforaminal epidural steroid injection is a rare and devastating complication.
We calculated the incidences of primary and secondary spinal cord infarction adjusted for age and sex based on the 2010 us census 189,093 resident populations. However, 62% of aqp4ab positive nmosd cases have lesions located within 7 cm of the foramen magnum, compared with no cases of spinal cord infarction. Spinal cord infarction after surgery in a patient in the hyperlordotic position. Jul 26, 2018 occlusive vascular lesions affecting the spinal cord spinal stroke are diagnostic challenges. Acute spinal cord infarction sci is uncommon, accounting for 1. In general, the higher on the spinal cord the injury occurs, the. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Lai, spinal cord infarction caused by cardiac tamponade, american journal of physical medicine and rehabilitation, vol. The location of the injury is also a good indicator of prognosis. Most of the time, this is a result of a narrowing of the arteries blood vessels that supply blood to the spinal cord. Treatment options for this relatively rare condition also remain elusive. This is particularly damaging to the gray matter because of its high metabolic requirement. We describe the case of a 55yearold woman who developed spinal cord infarction following right l23 transforaminal epidural injection, diagnosed on the basis of clinical and mr imaging findings.
Anterior spinal artery infarct typically presents as a bilateral loss of motor function and paintemperature sensation, with relative sparing of proprioception and vibratory senses below the level of the lesion. Request pdf spinal cord infarction spinal cord ischemia is an uncommon disease, varying in its presentation, severity, and outcome. Symptoms include sudden and severe back pain, followed. Mechanisms of spinal cord ischemia several mechanisms can cause impaired perfusion of the spinal cord. To study the clinical evolution and the functional outcome of patients suffering from spinal cord infarction who were treated at the spinal cord injuries unit.
Patients typically present with acute paraparesis or quadriparesis, depending on the level of the spinal cord involved. Longitudinally extensive spinal cord infarction in cadasil. We calculated the incidences of primary and secondary spinal cord infarction adjusted for age and sex based on. Spinal cord infarction was defined by spinal cord cell death attributable to ischemia, based on pathological, imaging, or other objective evidence of spinal cord focal ischemic injury in a defined vascular distribution. Spinal cord infarction information page national institute. Vasculitis of the spinal cord neurology jama neurology. Spinal cord compression caused by trauma or neoplasm should be emergently ruled out. We report the case of a patient with an acute infarction of the cervical spinal cord after a multilevel transforaminal epidural steroid injection. Spinal cord infarction journal of stroke and cerebrovascular. Nov 01, 2006 the technique has been shown to be efficacious in relieving the patients symptoms. Etiologies of completed strokes were diverse and included rupture and surgical repair of aortic aneurysms, aortic dissection, aortic rupture and thrombosis, global ischemia, anterior spinal artery embolism, repair and thrombosis of spinal. Evaluation of a patient with spinal cord infarction after. Spinal cord infarction is an uncommon disease and as such is often a diagnostic challenge for clinicians. Spinal cord infarction is an uncommon but devastating disorder caused by various conditions.
The clinical diagnosis was an anterior spinal cord infarction. Spinal cord infarction is a stroke either within the spinal cord or the arteries that supply it. Two of them had a definite vascular cause and the two others had normal. Spinal cord infarction an overview sciencedirect topics. Spinal cord infarction new zealand medical student journal. Spinal cord infarction mimicking acute transverse myelitis. A practical approach to the diagnosis of spinal cord lesions. Spinal cord infarction sci is rarely caused by vertebral artery dissection vad, which is an important cause of posterior circulation stroke in young and middleaged patients. Concerning the cause of spinal cord infarction after anesthesia and surgery, there are few reports in the literature. Spinal cord infarction after surgery in a patient in the. Some people experience a spontaneous recovery after a spinal shock and spinal cord injury.
Although effective, there are a range of possible complications associated with this procedure. Spinal cord infarction msd manual professional edition. Spinal cord infarction richard satran, md v ascular disease of the spinal cord occurs with less frequency than in the brain. Spinal cord injury occurs when there is any damage to the spinal cord that blocks communication between the brain and the body. Acute spinal cord ischemia syndrome radiology reference. If you do have a spinal cord injury, youll usually be admitted to the intensive care unit for treatment. The lower the injury is, the less severe the mobility and other impairments will be. Spinal cord infarctions are rare and due to heterogeneous etiologies. These strokes are caused when the arteries supplying the spinal cord begin to thicken or close due to the development of fatty deposits or disease within the arteries.
If the neurologic manifestations are attributable to. Delayedonset paraplegia due to spinal cord infarction. Spinal cord infarction is much less frequent than cerebral infarction, accounting for only 1% of. The vascular anatomy of the spinal cord consists of one anterior spinal artery and two posterior spinal arteries, supplied in the cervical region from the vertebral arteries and in the lumbar region from intercostal arteries, mainly via the adamkiewicz artery. A spinal cord injury damage to any part of the spinal cord or nerves at the end of the spinal canal cauda equina often causes permanent changes in strength, sensation and other body functions below the site of the injury. Spinal cord infarction definition of spinal cord infarction. In a few cases, symptoms progress over several minutes or even a few hours. It is caused by arteriosclerosis or a thickening or closing of the major arteries to the spinal cord. A comparison between spinal cord infarction and neuromyelitis. Mr images and clinical features of 16 patients 11 male, 5 female with typical sudden onset of neurological deficits caused by spinal cord ischemia were evaluated.
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