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spinal cord infarction
The equivalent of a stroke within the spinal cord.
Etiology:
- arteriosclerosis of major arteries supplying the spinal cord (68%)
- fibrocartilaginous embolism (14%)
- aortic dissection (5%)
- hypercoagulability (4%)
- hypotension during cardiac surgery of aortic vascular surgery
- AV malformations
- embolism
Clinical manifestations:
- acute onset:
- symptoms generally appear within minutes or hours
- nadir reached within 4 hours in 56%, 4-12 hours in 21%, 2-24 hours in 14%, > 24 hours in 10% [2]
- stepwise decline was more common with presentation past 8 hours
- symptoms reflective of loss below level of infarction
- intermittent sharp or burning back pain
- aching pain down through the legs
- weakness in the legs
- paralysis
- loss of deep tendon reflexes
- loss of pain & temperature sensation (40%)
- urinary incontinence
Special laboratory:
- lumbar puncture & CSF analysis
- mild elevation of CSF WBC in 8%
- moderate elevation of CSF protein in 70%
Radiology:
- MRI of spinal cord
- normal in 1/4 of patients within 1st 24 hours
- intramedullary T2-weighted hyperintensity
- diffusion abnormality
- angiography may reveal vascular abnormality in a minority of patients [2]
Differential diagnosis:
- transverse myelitis
Management:
- treatment is symptomatic
- physical therapy
- occupational therapy
- catheter may be necessary for urinary incontinence
Prognosis:
- paralysis may persist for many weeks or be permanent
- most individuals have a good chance of recovery
General
syndrome
infarction
References
- Zalewski NL, Rabinstein AA, Krecke KN et al
Characteristics of spontaneous spinal cord infarction and proposed
diagnostic criteria.
JAMA Neurol 2018 Sep 24;
PMID: 30264146
https://jamanetwork.com/journals/jamaneurology/fullarticle/2702589
- Zalewski NL, Rabinstein AA, Krecke KN et al
Spinal cord infarction: Clinical and imaging insights from the
periprocedural setting.
J Neurol Sci. 2018 May 15;388:162-167.
PMID: 29627015
- NINDS Spinal Cord Infarction Information Page
https://www.ninds.nih.gov/Disorders/All-Disorders/Spinal-Cord-Infarction-Information-Page