Spinal cord infarction

Definition

Spinal cord infarction (sometimes called spinal stroke ) refers to injury to the spinal cord due to oxygen deprivation.

Description

Spinal cord infarction occurs when one of the three major arteries that supply blood (and therefore oxygen) to the spinal cord is blocked. As a result of such an occlusion, the spinal cord is deprived of oxygen, resulting in injury and destruction of the very vulnerable nerve fibers. The resulting disability will depend on what level of the spinal cord suffers the injury; everything below the area of the occlusion will be affected.

Demographics

Spinal cord infarction is a relatively rare condition, affecting about 12 in 100,000 people in the population.

Causes and symptoms

A variety of conditions can result in occlusion of the spinal arteries and spinal cord infarction, including:

• atherosclerosis of the aorta
• a dissecting aortic aneurysm (as well as surgical accidents that occur when clipping aortic aneurysms)
• a tumor or abscess impinging on an artery
• blockages in smaller blood vessels due to diabetes, polyarteritis nodosa, systemic lupus erythematosus, neurosyphilis, tuberculous meningitis, pneumococcal meningitis
• severe low blood pressure
• blood clots
• vasculitis

Rare cases of spinal cord infarction have resulted from conditions that exert pressure on the spine (pregnancy, back injury, exercise ), resulting in the core of a spinal disc (nucleus pulposus) extruding out of the disc and entering into a spinal artery, resulting in a blockage of blood flow.

Depending on the mechanism underlying the spinal cord infarction, the symptoms may begin abruptly and acutely or slowly and gradually. Specific symptoms depend on where in the spinal cord the infarction occurs. Symptoms can include pain ; paraplegia; quadriplegia; initially limp, floppy muscles that become tightly contracted (spastic) over the next several days; initial loss of reflexes, which become overactive (hyperreflexia) over the next several days; loss of the sense of pain and temperature; and loss of bladder and bowel control.

Diagnosis

Diagnosis is often made by excluding other conditions that might account for the patient's symptoms. Although many tests will not actually reveal spinal cord infarction as the reason for a patient's loss of function, it is important that a variety of tests are performed in order to search for potentially reversible causes of disability. MRI scanning may be helpful in this effort; it may not actually reveal images indicative of spinal cord infarction, however.

Treatment team

Individuals with spinal cord infarction are usually cared for by neurologists, physiatrists, physical therapists, and occupational therapists. Complications of spinal cord infarction may require consultation with urologists and pulmonologists.

Treatment

Once an individual has suffered a spinal cord infarction, there are no treatments that will reverse the damage. Some degree of functioning may return as the acute inflammation decreases. Underlying conditions that may have predisposed the individual to spinal cord infarction should certainly be addressed and treated.

Recovery and rehabilitation

Rehabilitation will involve teaching the individual new ways of being as independent as possible, based on the new limitations rendered by the disabilities of spinal cord infarction. The efforts of physical and occupational therapists will be crucial in this endeavor.

Prognosis

The prognosis of spinal cord infarction tends to be very poor. There is a high risk of death, either during the acute phase of infarction or over the long term, particularly due to blood clots in the lungs (pulmonary emboli) or infection of bladder, lungs, or skin ulcerations secondary to inactivity and debilitation. Disability is significant, with a risk of paraplegia or quadriplegia.

Special concerns

The sudden loss of normal functioning and independence that can occur due to spinal cord infarction can prompt severe depression . Supportive psychotherapy can be an important adjunctive aid to optimal recovery.

Resources

BOOKS

Hauser, Stephen L. "Diseases of the Spinal Cord." Harrison's Principles of Internal Medicine, edited by Eugene Braunwald, et al. NY: McGraw-Hill Professional, 2001.

Perron, Andrew D., and J. Stephen Huff. "Spinal Cord Disorders." Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed., edited by Lee Goldman, et al. St. Louis: Mosby, Inc., 2002.

Pryse-Phillips, William, and T. Jock Murray. "Infectious diseases of the nervous system." Noble: Textbook of Primary Care Medicine, edited by John Noble, et al. St. Louis: W. B. Saunders Company, 2001.

WEBSITES

National Institute of Neurological Disorders and Stroke (NINDS). NINDS Spinal Cord Infarction Information Page. January 28, 2003. (June 3, 2004). <http://www.ninds.nih.gov/health_and_medical/disorders/spinal_infarction.htm>.

ORGANIZATIONS

Christopher Reeve Paralysis Foundation/Paralysis Resource Center. 500 Morris Avenue, Springfield, NJ 07081. 973-379-2690 or 800-225-0292; Fax: 973-912-9433. [email protected]; [email protected]. <http://www.christopherreeve.org>.

National Spinal Cord Injury Association. 6701 Democracy Blvd. #300-9, Bethesda, MD 20817. 301-214-4006 or 800-962-9629; Fax: 301-881-9817. [email protected]. <http://www.spinalcord.org>.

Rosalyn Carson-DeWitt, MD