Spinal cord infarction is caused due to blockage of the major arteries supplying Spinal cord. Spinal cord infarction is most commonly caused due to atherosclerosis of spinal arteries. It may also be caused due to aortic atherosclerosis, dissecting aortic aneurysm (chest or back pain with diminished pulses in legs), or hypotension from any cause.
Cardiogenic emboli, vasculitis related to collagen vascular disease like SLE and the antiphospholipid antibody syndrome are other causes
Blood supply to the spinal cord
The cord is supplied by three arteries: a single anterior spinal artery
and paired
posterior spinal arteries.
Symptoms
Onset of symptoms is usually progressive over few minutes to few hours but it may be sudden and dramatic.
Acute infarction in area supplied by anterior spinal artery gives rise to following symptoms
- Paraplegia or quadriplegia depending on the level of infarct.
- Losses of pain and temperature sensation but, vibration and position sense are preserved.
- Patient complains of radiating back pain which is localized to the area of infarct.
- Initially areflexia is present due to spinal shock but, hyperreflexia and spasticity appear later
Infarction in the area supplied by the posterior spinal arteries results in loss of posterior column functions like loss of position and vibration sense and may not be noticed.
Diagnosis
MRI Imaging: Diagnosis is usually done by
MRI. MRI can give a clear picture of compressing space-occupying lesion.
Spinal CT: Spinal CT has only a small role in diagnosis
of spinal infarction.
Myelography: CT myelography
is more sensitive and is used when MRI is not available, contraindicated
or unsatisfactory.
Spinal angiography: Indicated in cases where spinal arteriovenous
malformations are suspected.
Treatment
Treatment is symptomatic and supportive and directed towards the causative condition. Physical and occupational therapy are recommended to help patient to recover from paralysis.
Catheterisation may be required if urinary continence is present.
Prognosis
Prognosis is variable and entirely depends on the severity of damage and how early the treatment has been started. Patients seeking early treatment recover better.