A spinal stroke, or spinal cord infarction, occurs when blood flow to the spinal cord is interrupted. This rare condition can lead to sudden, significant neurological impairment. Similar to a brain stroke, it impacts the spinal cord, a key part of the central nervous system.
What Exactly Is a Spinal Stroke?
The spinal cord relies on a consistent blood supply, primarily from a single anterior spinal artery and two posterior spinal arteries. Smaller radicular arteries further supply these. The anterior spinal artery typically supplies the front two-thirds; the posterior arteries supply the back one-third.
A spinal stroke damages spinal cord tissue when deprived of oxygen and nutrients. This results from either a blood vessel blockage (ischemic stroke) or bleeding from a ruptured vessel (hemorrhagic stroke). Ischemic strokes are more common, similar to brain strokes. While both brain and spinal strokes involve impaired blood flow, their locations cause distinct symptoms.
Causes and Contributing Factors
Ischemic spinal strokes often arise from conditions impeding blood flow, such as blood clots within spinal cord vessels or those traveling from elsewhere. Atherosclerosis, plaque buildup inside arteries causing narrowing and hardening, is a frequent underlying factor. Other causes include complications from aortic diseases (dissections or aneurysm repairs), vasculitis, very low blood pressure, or spinal trauma.
Hemorrhagic spinal strokes are less frequent. They can be caused by very high blood pressure, which weakens and ruptures blood vessels. Abnormalities in blood vessels, such as aneurysms (bulges in artery walls) or arteriovenous malformations (AVMs), can also lead to bleeding. Bleeding disorders or anticoagulant medications can also increase this risk.
Several general health conditions and lifestyle choices increase the risk for both types of spinal strokes. These include chronic conditions like high blood pressure, high cholesterol, and diabetes. Lifestyle factors such as smoking, obesity, and a lack of regular physical activity also contribute to the risk by putting additional strain on the circulatory system.
Identifying the Symptoms
Symptoms of a spinal stroke appear suddenly, often within minutes to hours, and can worsen. Specific symptoms depend on the exact location and extent of spinal cord damage, as different segments control various bodily functions.
A common initial symptom is sudden, severe pain in the back or neck, which may radiate. This can be accompanied by muscle weakness or paralysis in the limbs, often affecting both sides below the stroke level. Individuals may also experience numbness, tingling, or a loss of sensation, including temperature distinction.
Other signs include difficulty walking or maintaining balance, and issues with bladder or bowel control (e.g., incontinence). If the stroke affects the upper cervical (neck) spinal cord, breathing difficulties may occur. Recognizing these symptoms and seeking immediate medical attention is crucial, as timely intervention significantly influences the outcome.
Diagnosis and Medical Care
Diagnosing a spinal stroke begins with a thorough clinical and neurological examination, assessing symptoms, reflexes, and motor/sensory functions. Due to rarity and symptom overlap, imaging tests are essential for accurate diagnosis and to exclude other potential causes of spinal cord dysfunction.
Magnetic Resonance Imaging (MRI) is the primary diagnostic tool for spinal strokes. An MRI provides detailed spinal cord images, helping identify damage, blood clots, or bleeding, and can rule out other conditions like tumors or inflammation. Computed Tomography (CT) scans may also be used, particularly in emergencies, to quickly assess for bleeding or other structural issues. In some cases, angiography may pinpoint blockages or vessel abnormalities.
Immediate medical care focuses on stabilizing the patient and minimizing further spinal cord damage. For ischemic strokes, treatments may involve medications like blood thinners (anticoagulants) or clot-busting drugs (thrombolytics) to restore blood flow. Surgical procedures like mechanical thrombectomy may remove a blood clot in specific situations. For hemorrhagic strokes, the aim is to stop bleeding and manage blood pressure, sometimes requiring surgery to relieve spinal cord pressure. Medications may also control blood pressure and cholesterol, addressing underlying risk factors.
Navigating Recovery
Recovery from a spinal stroke varies significantly among individuals, depending on the severity and location of the stroke, and how quickly treatment was initiated. While some individuals may experience substantial improvement, others may face long-term challenges.
Rehabilitation is a cornerstone of recovery, often beginning soon after acute treatment. Physical therapy helps individuals regain strength, improve mobility, and restore balance. Occupational therapy assists in relearning daily activities and adapting to lingering physical limitations. Psychological support can also be beneficial, as individuals may experience emotional challenges like depression during recovery.
Long-term complications can include persistent muscle weakness, numbness, chronic pain, and spasticity (muscle stiffness). Bladder and bowel dysfunction are common, and some individuals may experience sexual problems. Recovery can be prolonged, potentially taking months or years, and often requires ongoing support and lifestyle adjustments to manage symptoms and reduce future risk.