Spinal cord infarction, often called a “spinal stroke,” is a rare but serious medical emergency. It results from a sudden interruption of blood flow to the spinal cord, leading to tissue death. When blood supply is compromised, nerves cannot receive adequate oxygen and nutrients, causing rapid dysfunction and potential permanent damage. Though uncommon, it can occur anywhere along the spinal cord and have severe neurological consequences.
Understanding Spinal Cord Infarction
Spinal cord infarction develops when the blood supply to the spinal cord is disrupted, causing ischemia, a lack of oxygen and nutrients. The spinal cord receives blood primarily from one anterior spinal artery and two posterior spinal arteries. The anterior spinal artery supplies the front two-thirds of the spinal cord, responsible for motor function and pain/temperature sensation. This makes the anterior spinal artery territory particularly vulnerable due to its single supply and limited collateral circulation.
Common causes include atherosclerosis, where arteries narrow and harden due to fatty deposits. Aortic pathologies, such as aortic dissection, aneurysms, or thrombosis, are also frequently associated. Certain surgical procedures, particularly those involving the aorta, can inadvertently compromise spinal cord blood supply. Other causes include vasculitis, blood clotting disorders, cardiac embolism, and severe systemic hypotension.
A common presentation is anterior spinal artery syndrome, which results from ischemia in the area supplied by the anterior spinal artery, affecting the anterior two-thirds of the spinal cord. This leads to specific neurological deficits, including motor weakness or paralysis, and loss of pain and temperature sensation. Light touch, proprioception, and vibratory sensation are generally preserved. The midthoracic cord (T5-10) has the most tenuous arterial blood supply, making it a common site for infarction.
Recognizing the Symptoms
Symptoms of spinal cord infarction typically appear suddenly, often within minutes to a few hours. A common initial symptom is acute, severe back pain, which may be sharp or burning and can radiate downwards.
Following pain onset, individuals usually experience rapidly progressive motor weakness or paralysis. This weakness often affects both legs, but can sometimes involve the arms or be unilateral depending on the infarction’s location. Initially, paralysis may be flaccid with a loss of deep tendon reflexes, evolving into spasticity and hyper-reflexia over days or weeks.
Sensory changes are also characteristic, particularly a loss of pain and temperature sensation below the affected spinal cord level. However, light touch, vibration, and proprioception are often preserved. Many individuals also experience bladder and bowel dysfunction. If the infarction occurs in the upper cervical spine, it can lead to breathing difficulties.
Diagnosis and Immediate Treatment
Diagnosing spinal cord infarction involves a prompt assessment to differentiate it from other conditions with similar symptoms. A neurological examination and medical history evaluate the extent of deficits. Imaging techniques confirm the diagnosis and rule out other causes of spinal cord dysfunction.
Magnetic Resonance Imaging (MRI) of the spine is the preferred imaging method. MRI can detect ischemic changes in the spinal cord. In some cases, an “owl-eyes” pattern may appear on images. While MRI is useful, it may not always detect abnormalities in the first few hours after symptom onset. Diffusion-weighted imaging (DWI) can also aid early diagnosis. Other tests, such as CT scans, blood tests, or cerebrospinal fluid analysis, may identify underlying causes or exclude other conditions.
Immediate treatment focuses on stabilizing the patient and preventing further damage. There are currently no standard specific treatments for spinal cord infarction, so management involves addressing the underlying cause and providing supportive care. Blood pressure management is important to ensure adequate spinal cord perfusion, and pain control is also considered. In rare cases, thrombolytic therapy, which aims to dissolve blood clots, may be considered if diagnosed early, though its routine use is not well-established. Antiplatelet agents or anticoagulation may be used if vascular risk factors exist to reduce the risk of further events.
Rehabilitation and Long-Term Outlook
Rehabilitation is important for recovery after a spinal cord infarction, beginning soon after medical stabilization. Its goal is to optimize recovery, manage residual symptoms, and help individuals adapt to lasting changes. A multidisciplinary team, including physical, occupational, and sometimes speech therapists, works with the patient.
Physical therapy focuses on regaining strength, improving mobility, and preventing complications. Occupational therapy helps individuals relearn daily living activities and may involve adapting techniques or using assistive devices. For those with speech or swallowing difficulties, speech therapy provides targeted interventions. Rehabilitation can be a long and intensive process, often continuing for many years, with therapies tailored to individual deficits.
The potential for recovery varies and depends on factors like severity, location, and how quickly treatment was initiated. Some individuals experience significant improvement, while others have lasting neurological deficits. Gradual improvement is common and can continue long after initial hospitalization. For example, many patients who initially require a wheelchair may regain the ability to walk, sometimes with aids. Similarly, many who initially require catheterization may regain bladder control. Long-term management often includes addressing residual symptoms like chronic pain, spasticity, and bladder or bowel dysfunction, along with supportive care and lifestyle adjustments to manage underlying risk factors.