Spinal cord infarction

Question 1

What usually causes spinal cord infarction?

Answer 1

usually results from ischaemia originating in an extravertebral artery

Question 2

What is the typical progression of symptoms of spinal cord infarction?

Answer 2

sudden and severe back pain, followed immediately by rapidly progressive bilateral flaccid limb weakness and loss of sensation, particularly pain and temperature

Question 3

How can the vascular supply of the spinal cord be split up and what supplies it?

Answer 3

• posterior third vs. anterior two thirds
• anterior two thirds: anterior spinal artery
• posterior third: posterior spinal arteries

Question 4

What supplies the anterior spinal artery?

Answer 4

• in the upper cervical region, only a few feeder arteries
• one large feeder artery, the artery of Adamkiewicz in the lower thoracic region
• feeder arteries originate in the aorta

Question 5

Why are parts of the spinal cord susceptible to ischaemia and which are they?

Answer 5

• collateral circulation for the anterior spinal artery is sparse in places
• e.g. those around 2nd-4th thoracic segments

Question 6

Injury to which arteries most commonly cause spinal infarction?

Answer 6

• injury to extravertebral feeder artery or the aorta rather than intrinsic disorders of spinal arteries

Question 7

What are 3 of the most common causes of spinal artery infarction?

Answer 7

1. Atherosclerosis
2. Dissection
3. Clamping during surgery

Question 8

What are 2 uncommon causes of spinal infarction?

Answer 8

1. Thrombosis - uncommon
2. Polyarteritis nodosa - rare

Question 9

What are 5 possible clinical features of spinal cord infarction?

Answer 9

1. First symptom: sudden pain in the back with tightness radiating circumferentially
2. Followed within minutes by segmental bilateral flaccid weakness
3. Sensory loss; pain and temperature sensation disproportionately impaired
4. Position and vibration sensation, conducted by posterior columns, and often light touch are relatively spared
5. If infarct small and affects primarily tissue farthest away from an occluded artery (towards centre of cord), central cord syndrome is also possible

Question 10

Why are pain and temperature sensation often disproportionately impaired in spinal cord infarction?

Answer 10

anterior infarction more common

pain and temperature are carried by the lateral spinothalamic tract in the anterior segment whereas light touch is carried by the ventral spinothalamic tract and position and vibration sensation are carried in the dorsal column, i.e. at the back

Question 11

What is typically the first symptom of spinal cord ifnarction?

Answer 11

sudden pain in the back with tightness radiating circumferentially

Question 12

What is the nature of the weakness in spinal cord infarction?

Answer 12

follows the back pain after minutes, segmental bilateral flaccid weakness

Question 13

Which segment of the spinal cord is most commonly affected in spinal cord infarction?

Answer 13

anterior spinal artery territory - anterior cord sndrome

Question 14

What may be the outcome of neurologic deficits in spinal cord infarction?

Answer 14

they may partially resolve after the first few days

Question 15

What is the key investigation needed to make a diagnosis of spinal cord infarction?

Answer 15

MRI

Question 16

What can be done if MRI is not available to diagnose spinal infarction?

Answer 16

CT myelography

Question 17

What is the treatment of spinal cord infarction?

Answer 17

supportive care

occasionally, the cause of infarction e.g. aortic dissection, polyarteritis nodosa, can be treated but often only possible treatment is supportive

Question 18

What does central cord syndrome mean? 3 aspects

Answer 18

1. Paresis tending to be more severe in the upper extremities than lower extremities and sacral regions
2. tendency to lose pain and temperature sensation in a cape-like distribution over the upper neck, shoulders, and upper trunk
3. light touch, position and vibratory sensation relatively preserved (dissociated sensory loss)