Spinal Cord Infarction

Background

• Acute paraparesis or quadriparesis
• Depending on the level of cord involved

Aetiology

• Aortic disease/surgery
• Systemic hypoperfusion
• Cardiogenic embolism
• Vasculitis
• Hypercoagulable conditions
• Spinal disease/surgery
• Spinal vascular malformation
• Vertebral artery dissection
• Cocaine
• Infection

Clinical

Anterior spinal artery syndrome commonest:

• Loss motor & pain/temp. below level of the lesion

Other signs of spinal cord infarction include:

• Weakness and/or numbness:
  • Flaccid weakness acutely (spasticity later)
• Back or neck pain:
  • Typically, at the level of the lesion
• Reflex abnormalities:
  • Loss of reflexes acutely, hyperreflexia later
• Autonomic dysfunction:
  • Haemodynamic instability, bladder/bowel dysfunction, sexual dysfunction
• Brown-sequard syndrome:
  • Unilateral flaccid weakness ipsilateral to and below level of lesion, plus contralateral loss of pain/temperature sensation with preservation of position sense vibration

Differential Dx

• Extra-axial compression:
  • Neoplasms
  • Epidural/subdural haematomas
  • Spinal abscess
  • Cervical/thoracic disc herniation
• Inflammatory or infiltrative spinal conditions
• Acute polyneuropathies:
  • Guillain-Barré syndrome
• Brainstem or cerebral conditions:
  • Ischaemia, haemorrhage, or neoplasms
• Aortic dissection

Investigations

Management

• Maintain MAP (autonomic dysfunction) ± vasopressors
• Dependent on the underlying cause ±CTS aortic dissection
• Cardiology / ID if infective endocarditis
• Vertebral art. dissection: Stroke
• Acute spontaneous spinal cord infarction: aspirin or clopidogrel
• Early "stroke" referral, management and rehab.

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