spinal cord infarction

Introduction

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%
  • 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

Diagnostic procedures

• 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

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

More general terms

• syndrome
• infarction

Patient information

spinal cord infarction patient information