Overview
Spinal cord stroke, also known as spinal cord infarction, involves the interruption of blood supply to the spinal cord, leading to neurological deficits that can manifest as monoplegia, paraplegia, or paraparesis. 1Diagnosis
Clinical Presentation: Acute onset of motor deficits, often monoplegic but can be paraplegic or paraparetic.
Imaging: MRI showing T2 hyperintensity, contrast enhancement, and diffusion restriction indicative of infarction.
Laboratory Tests: Elevated cerebrospinal fluid myelin basic protein levels may support diagnosis.
Anatomical Considerations: Presence of spinal column abnormalities like herniated discs or Schmorl's nodes may suggest embolism mechanisms.
Angiography: Limited utility due to potential artifacts; spinal cord angiography may be considered if feasible.
Prothrombotic Evaluation: Rule out underlying prothrombotic states, though often unremarkable in cases.
Differential Diagnosis: Exclude other causes like compressive lesions or inflammatory conditions. 1Management
Supportive Care: Focus on maintaining respiratory function, preventing complications like pressure sores, and providing physical therapy.
Rehabilitation: Early initiation of multidisciplinary rehabilitation programs to optimize recovery.
Antithrombotics: Consideration in selected cases post-acute phase, though specific dosing not detailed in current abstract.
Monitoring: Regular neurological assessments to track progression or improvement.
Pain Management: Address associated pain with appropriate analgesics as needed.
Secondary Prevention: Manage identified risk factors such as hypertension and hyperlipidemia. 1Special Populations
Pediatrics: Presentation can occur in adolescents, as seen in a 17-year-old with monoplegia following intense physical activity. 1
Comorbidities: Consider spinal column anomalies (e.g., herniated discs, Schmorl's nodes) as potential contributing factors in certain cases. 1Key Recommendations
MRI for Diagnosis: Utilize MRI to confirm spinal cord infarction through characteristic imaging findings. (Evidence: Moderate) 1
Early Rehabilitation: Initiate multidisciplinary rehabilitation early to enhance functional recovery. (Evidence: Expert opinion) 1
Evaluate Spinal Anatomy: Assess for spinal column abnormalities like herniated discs or Schmorl's nodes, which may indicate embolism risk. (Evidence: Moderate) 1References
1 Nelson JA, Ho CY, Golomb MR. Spinal Cord Stroke Presenting With Acute Monoplegia in a 17-Year-Old Tennis Player. Pediatric neurology 2016. link