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Infarction of spinal cord — Clinical Guidelines

Overview

Spinal cord infarction (SCI) is a rare form of stroke characterized by ischemic damage to the spinal cord, often leading to significant neurological deficits. It can result from various etiologies including vascular dissections, emboli, and intrinsic spinal vascular anomalies 1 2 10 14 21.

Diagnosis

Clinical Manifestations: Motor and sensory deficits, often localized to specific spinal levels 1 2 7 13.

Imaging: MRI is crucial, showing hyperintense lesions on T2-weighted images 1 2 7.

Laboratory Findings: Not typically specific; may include markers of inflammation or coagulation abnormalities 1.

Differential Diagnosis: Exclude other causes such as compressive lesions, inflammatory conditions, and metabolic disorders 1 7.

Management

Prompt Diagnosis: Early recognition is critical for potential therapeutic interventions 3 1.

Thrombolytic Therapy: Intra-arterial thrombolysis has shown promise in selected cases, particularly for anterior spinal artery territory ischemia 3.

Supportive Care: Focus on preventing complications, including respiratory support and management of spasticity 1 17.

Rehabilitation: Early initiation of physical and occupational therapy to optimize recovery 1 17.

Special Populations

Pediatrics: Fibrocartilaginous embolism (FCE) is a recognized cause in children, often following minor trauma or activity 4 6 20.

Elderly: Increased risk of SCI due to degenerative vascular changes and comorbidities like cervical spondylosis 7 19.

Comorbidities: Congenital afibrinogenemia can predispose to vertebral artery dissection leading to SCI 10.

Key Recommendations

Utilize MRI for definitive diagnosis of spinal cord infarction, focusing on characteristic imaging features 1 2 (Evidence: Strong).

Consider intra-arterial thrombolysis in acute cases with appropriate vascular anatomy and timing 3 (Evidence: Moderate).

Initiate comprehensive rehabilitation early to enhance functional outcomes 1 17 (Evidence: Moderate).

Differentiate SCI from compressive lesions through clinical evaluation and imaging to guide management 1 7 (Evidence: Moderate).

Monitor and manage complications such as respiratory issues and spasticity in affected patients 1 17 (Evidence: Expert opinion).

References

1 Ke G, Liao H, Chen W. Clinical manifestations and magnetic resonance imaging features of spinal cord infarction. Journal of neuroradiology = Journal de neuroradiologie 2024. link 2 Ros Castelló V, Sánchez Sánchez A, Natera Villalba E, Gómez López A, Parra P, Rodríguez Jorge F et al.. Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients. Neurologia 2023. link 3 Haynes J, Shapiro M, Raz E, Czeisler B, Nossek E. Intra-arterial thrombolytic therapy for acute anterior spinal artery stroke. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2021. link 4 Ahluwalia R, Hayes L, Chandra T, Maugans TA. Pediatric fibrocartilaginous embolism inducing paralysis. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2020. link 5 AbdelRazek MA, Mowla A, Farooq S, Silvestri N, Sawyer R, Wolfe G. Fibrocartilaginous embolism: a comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria. The journal of spinal cord medicine 2016. link 6 Rengarajan B, Venkateswaran S, McMillan HJ. Acute asymmetrical spinal infarct secondary to fibrocartilaginous embolism. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2015. link 7 Nakae Y, Johkura K, Kudo Y, Kuroiwa Y. Spinal cord infarction with cervical angina. Journal of the neurological sciences 2013. link 8 Theobald A, Volk HA, Dennis R, Berlato D, De Risio L. Clinical outcome in 19 cats with clinical and magnetic resonance imaging diagnosis of ischaemic myelopathy (2000-2011). Journal of feline medicine and surgery 2013. link 9 Mateen FJ, Monrad PA, Leep Hunderfund AN, Robertson CE, Sorenson EJ. Clinically suspected fibrocartilaginous embolism: clinical characteristics, treatments, and outcomes. European journal of neurology 2011. link 10 Laufs H, Weidauer S, Heller C, Lorenz M, Neumann-Haefelin T. Hemi-spinal cord infarction due to vertebral artery dissection in congenital afibrinogenemia. Neurology 2004. link 11 Bandyopadhyay S, Sheth RD. Acute spinal cord infarction: vascular steal in arteriovenous malformation. Journal of child neurology 1999. link 12 Yousef OM, Appenzeller P, Kornfeld M. Fibrocartilagenous embolism: an unusual cause of spinal cord infarction. The American journal of forensic medicine and pathology 1998. link 13 Gutowski NJ, Murphy RP, Beale DJ. Unilateral upper cervical posterior spinal artery syndrome following sneezing. Journal of neurology, neurosurgery, and psychiatry 1992. link 14 Moorhouse DF, Burke M, Keohane C, Farrell MA. Spinal cord infarction caused by cartilage embolus to the anterior spinal artery. Surgical neurology 1992. link90133-8) 15 Sandson TA, Friedman JH. Spinal cord infarction. Report of 8 cases and review of the literature. Medicine 1989. link 16 Kestle JR, Resch L, Tator CH, Kucharczyk W. Intervertebral disc embolization resulting in spinal cord infarction. Case report. Journal of neurosurgery 1989. link 17 Satran R. Spinal cord infarction. Stroke 1988. link 18 Levin KH, Daube JR. Spinal cord infarction: another cause of "lumbosacral polyradiculopathy". Neurology 1984. link 19 Blumbergs PC, Chin D, Rice JP. Hypotensive central spinal cord infarction: a clinicopathological study of 3 cases of aortic disease. Clinical and experimental neurology 1981. link 20 Bots GT, Wattendorff AR, Buruma OJ, Roos RA, Endtz LJ. Acute myelopathy caused by fibrocartilaginous emboli. Neurology 1981. link 21 Ho KL, Gorell JM, Hayden MT. Fatal spinal cord infarction caused by fibrocartilaginous embolization of the anterior spinal artery. Human pathology 1980. link80056-6) 22 Griffiths IR, Barker J, Palmer AC. Cholesterol masses in association with spinal cord infarction due to intervertebral disc emboli. Acta neuropathologica 1975. link

Infarction of spinal cord