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[Acute ischemic spinal cord disease. Spinal cord infarction. A clinical study and MRI in 8 cases]
1Servei de Neurologia, Hospital del Mar. Unisersitat Autònoma de Barcelona, España.
Abstract:
Acute spinal cord infarction (ASCI) occurs infrequently and may have diverse causes. The diagnosis of ASCI, and particularly of an anterior spinal artery syndrome (ASAS) can be confirmed nowadays by MRI, whereas in the past only necropsy confirmation was possible. Pathophysiology and long-term prognosis may be better known at present and treatments more consistent. We present the longitudinal study and clinical features of 8 patients suffering from ASCI. All of them were personally studied and had MRI examinations, often with sequential studies. three groups must be considered: one included 4 cases of ASAS at cervical level, the second 2 cases of ASAS at thoracic level and the third group with infarction of the conus medullaris (ICM), one of them developed during surgical repair of an infrarenal aortic aneurysm. Motor and sensory sequelae were assessed in each case together with possible etiological factors. In conclusion, recovery after ASAS tends to be dependent on the severity of the initial deficit. At cervical level, clinical and morphological findings argue in favour of an extrinsic selective compression of the C7 right radiculo-medullary artery as responsible for the ASA. At thoracic level, the artery preferentially occluded seems to be the sulco-commisural artery as a consequence of disc compression. Finally, an underlying peculiarity of the pattern of arterial supply is a probable predisposing factor for ICM. Generally, the long-term prognosis of ASCI is not necessarily bad.
Insights
Acute spinal cord infarction (ASCI) is rare but treatable. Recovery from anterior spinal artery syndrome (ASAS) depends on initial deficit severity, with varied causes and generally not a poor long-term prognosis.
Area of Science:
- Neurology
- Vascular Neurology
- Spinal Cord Medicine
Background:
- Acute spinal cord infarction (ASCI) is an infrequent condition with varied etiologies.
- Advances in MRI have improved diagnosis of ASCI, particularly anterior spinal artery syndrome (ASAS), previously requiring necropsy.
- Current understanding of ASCI pathophysiology, prognosis, and treatment has advanced.
Observation:
- A longitudinal study examined 8 patients with ASCI, including cervical ASAS, thoracic ASAS, and conus medullaris infarction (ICM).
- MRI, often sequential, was used for diagnosis and assessment of motor and sensory sequelae.
- One case of ICM occurred during surgical repair of an infrarenal aortic aneurysm.
Findings:
- Cervical ASAS was linked to extrinsic compression of the C7 right radiculo-medullary artery.
- Thoracic ASAS was associated with occlusion of the sulco-commisural artery due to disc compression.
- Anomalies in arterial supply patterns may predispose individuals to ICM.
Implications:
- Recovery from ASAS is contingent upon the severity of the initial neurological deficit.
- Understanding specific etiological factors aids in targeted treatment and management of ASCI.
- The long-term prognosis for ASCI is not uniformly poor, suggesting potential for recovery and improved outcomes.