Blood Supply of the Spinal Cord Flashcards
Describe the blood supply of the spinal cord.
Anterior spinal artery (single)
Anterior 2/3rds of spinal cord
Motor area - anterior horn
Posterior spinal arteries (paired)
Posterior columns
Segmental arteries - 21 pairs
In which layer around the spinal cord are the spinal arteries and veins located?
In between the arachnoid mater and pia mater
What sort of pathologies can you get in the spinal arteries?
Anterior spinal artery occlusion is most common Aetiology: - Disease of the aorta - aneurysm, trauma, dissection - Atherosclerosis - Aortic surgery - Vasculitis (GCA) - Sickle cell disease - Hypotension - Cardiac emboli - Disc herniation
How does an anterior spinal artery occlusion present?
Acute (80% are painful Fever is a red flag - Acute bacterial meningitis - Epidural/subdural abscess - Granuloma - Viral illness 95% are anterior spinal infarcts
What is found on examination of a spinal blood supply injury?
Spinal shock initially
- Flaccid weakness
- Areflexic
- Anaesthesia
Loss of pain and temperature, but posterior column modalities preserved
Progresses to UMN signs with muscle atrophy/sensory level and sphincter disturbance
What are some of the differential diagnosis’ of a spinal blood supply injury?
Mass lesion - Tumour, abscess, granuloma, haematoma, herniated disc Intraspinal haemorrhage Acute inflammation demyelinating polyneuropathy - E.g. Guillain-Barre Syndrome Demyelination, transverse myelitis Sarcoid, TB, syphilis
How is spinal cord blood supply injury managed?
Early identification of reversible causes
Treat cause
Manage vascular risk factors (where indicated)
Rehabilitation
Prevention of complications
Prognosis variable (but poor)