A spinal stroke, also known as a spinal cord infarction, occurs when the blood supply to the spinal cord is disrupted. Spinal strokes are rare, accounting for less than 1% of all strokes. Despite their rarity, these events can have a significant and lasting impact.
Understanding a Spinal Stroke
A spinal stroke involves an interruption of blood flow within the spinal cord, starving the tissue of vital oxygen and nutrients and leading to cell damage or death. The spinal cord, a complex bundle of nerves, transmits signals between the brain and the rest of the body, controlling movement, sensation, and organ function.
The spinal cord receives its blood supply through a network of arteries, notably the anterior spinal artery and two posterior spinal arteries. The anterior spinal artery supplies the front two-thirds of the spinal cord, making it the most common site for spinal strokes. When blood flow is compromised in this area, it can lead to anterior spinal artery syndrome.
Causes and Risk Factors
Spinal strokes typically arise from either a blockage in a blood vessel (ischemic stroke) or bleeding from a ruptured vessel (hemorrhagic stroke). Ischemic spinal strokes are more common, often resulting from blood clots or the narrowing of arteries due to plaque buildup (atherosclerosis).
Conditions that increase the risk of an ischemic spinal stroke include high cholesterol, high blood pressure, and heart defects. Blood clots can form in these narrowed arteries or travel from other parts of the body to the spinal cord. Hemorrhagic spinal strokes, though less frequent, can be caused by very high blood pressure, spinal tumors, or aneurysms, which are balloon-like bulges in blood vessel walls that can burst. Certain medical procedures, such as aortic surgery, also carry a risk of spinal stroke due to interference with the spinal cord’s blood supply.
Recognizing the Signs
The symptoms of a spinal stroke typically appear suddenly and can vary depending on the specific area of the spinal cord affected. A common initial symptom is sudden, intense pain in the neck or back, which may radiate to the arms or legs. This pain can sometimes feel like a tight band around the body, indicating the level of the spinal cord where the blood supply is disrupted.
Weakness or paralysis in the limbs is another prominent sign. This can manifest as weakness in the legs (paraplegia) or, in more severe cases, in all four limbs (quadriplegia). Individuals may also experience a loss of sensation, including numbness, tingling, or an inability to feel temperature changes. Bladder and bowel dysfunction, such as incontinence, is also common, as these functions are controlled by the spinal cord.
Diagnosis and Treatment Approaches
Diagnosing a spinal stroke requires prompt medical attention and a thorough evaluation, as its symptoms can overlap with other spinal cord conditions. Healthcare providers typically conduct a physical and neurological examination. The primary diagnostic tool for confirming a spinal stroke is Magnetic Resonance Imaging (MRI) of the spine. An MRI can reveal signs of a stroke, identify the location of the damage, and help rule out other causes such as tumors or infections.
Treatment for a spinal stroke focuses on supportive care and addressing the underlying cause to prevent further damage. For ischemic strokes, medications may be administered to thin the blood and reduce the risk of further clotting, such as antiplatelet drugs or anticoagulants. Unlike brain strokes, specific clot-busting drugs (thrombolytics) are not routinely used for spinal strokes due to different mechanisms and associated risks. Maintaining stable blood pressure is also a significant aspect of acute management. In cases of hemorrhagic stroke, treatment aims to stop the bleeding and manage any increased pressure on the spinal cord, sometimes requiring surgery.
Recovery and Outlook
Recovery from a spinal stroke can vary significantly, depending on the severity of the initial injury and how quickly treatment was initiated. While many people experience some neurological improvement, permanent weakness in the legs is common, and some may require mobility aids or a wheelchair. The recovery process can extend over months or even years.
Rehabilitation plays a significant role in maximizing functional recovery after a spinal stroke. Physical therapy helps to strengthen muscles, improve balance, and regain mobility through targeted exercises. Occupational therapy assists individuals in adapting to any remaining limitations and performing daily tasks independently. Long-term challenges can include persistent muscle weakness, spasticity (muscle stiffness), sensory issues, and bowel or bladder dysfunction.