Spinal cord infarction, often called a spinal stroke, is a rare but serious medical event involving an abrupt interruption of blood flow to the spinal cord. This condition is a medical emergency that shares a mechanism with the more common brain stroke, resulting in tissue death, or infarction, within the central nervous system. The sudden lack of oxygen and nutrients leads to a dramatic and immediate onset of neurological deficits.
How Blood Flow to the Spinal Cord is Interrupted
The spinal cord receives blood supply from a network of arteries, primarily the single anterior spinal artery supplying the front two-thirds of the cord. This area includes the tracts responsible for motor function and most sensory information. The blood flow is reinforced by several segmental arteries branching off the aorta, most notably the great anterior segmental artery of Adamkiewicz, which supplies the lower two-thirds of the spinal cord.
A spinal stroke most commonly occurs when a blockage, such as a blood clot or an embolus, obstructs one of these feeding vessels, causing ischemia. This mechanism, known as an ischemic stroke, accounts for the majority of spinal cord infarctions. Because the spinal cord has a limited ability to reroute blood flow through collateral vessels, a prolonged interruption quickly starves the tissue of oxygen. This rapid deprivation leads to the death of nerve cells and determines the severity of the neurological impairment.
Recognizing the Sudden Onset of Symptoms
The onset of a spinal stroke is acute and dramatic, often beginning with intense, localized pain in the back or neck at the level of cord involvement. This severe pain is quickly followed by the development of profound muscle weakness. The weakness frequently affects both sides of the body, progressing rapidly to partial or complete paralysis, most often in the legs.
A defining characteristic of an anterior spinal artery infarction is a specific pattern of sensory loss below the level of injury. Individuals often lose the ability to sense pain and temperature, as these signals travel through the compromised front portion of the spinal cord. However, the ability to detect vibration and position sense is preserved because those sensory pathways travel through the posterior columns, which have a separate blood supply. The neurological event can also disrupt the autonomic nervous system, leading to the loss of bladder and bowel control.
Underlying Conditions That Increase Risk
Spinal strokes are linked to pre-existing conditions that compromise vascular health. Systemic vascular diseases, such as atherosclerosis, high blood pressure, and diabetes, significantly increase the likelihood of arterial blockage throughout the body, including the spinal cord’s supply lines. These conditions can lead to the formation of plaques or clots that obstruct the smaller spinal arteries.
Aortic disease is a prominent risk factor, as the spinal cord’s blood supply directly branches off the aorta. Conditions like aortic dissection or surgical procedures on the aorta, such as those for an aortic aneurysm, can disrupt blood flow to the spinal arteries. Cardiac conditions that predispose individuals to blood clots, like atrial fibrillation, can cause an embolus to lodge in one of the spinal cord’s feeding vessels.
Confirming the Diagnosis and Initial Treatment
Diagnosing a spinal stroke relies on a high degree of clinical suspicion due to the sudden nature of symptoms and the specific pattern of neurological deficit. Imaging is necessary to confirm the infarction and rule out conditions that mimic a spinal stroke, such as a tumor, abscess, or compressive hematoma. Magnetic Resonance Imaging (MRI) of the spine is the preferred diagnostic tool, as specialized sequences can detect early signs of tissue damage from ischemia and exclude spinal cord compression.
Acute treatment focuses on supportive care aimed at maximizing blood flow to the damaged area. Unlike strokes in the brain, direct clot-busting medications are rarely used for spinal infarction. Medical teams work to maintain adequate blood pressure, which helps ensure enough blood perfuses the compromised spinal cord tissue. Addressing the underlying cause, such as controlling blood pressure or treating a cardiac source of emboli, is part of the immediate management plan.
Recovery and Long-Term Rehabilitation
The long-term outcome following a spinal stroke is highly variable and depends on the initial severity and extent of the damage. Improvement in function can occur over months or even years, as the nervous system attempts to recover through neuroplasticity. Multidisciplinary rehabilitation is necessary to maximize functional independence.
Physical therapy strengthens muscles and improves mobility, while occupational therapy focuses on adapting daily tasks and environments to the individual’s new functional level. Individuals may face chronic complications, including muscle spasticity (involuntary tightness and stiffness) and neuropathic pain (pain originating from the damaged nerves). Managing these persistent symptoms requires a combination of medication and continued therapeutic interventions.