Vascular Diseases Of The Spinal Cord

SPINAL CORD INFARCTION Anterior spinal artery syndrome

The level at which infarction occurs determines symptoms and signs. Characteristic features include:

- Radicular pain at onset

- Sudden para/quadraplegia

- Flaccid limbs tUys ■ spastic

- Areflexia-^i!—► hyper-reflexia and extensor plantar responses

- Sensory loss to pain and temperature up to the level of cord damage

- Preserved vibration and joint position sensation (dorsal columns supplied by the posterior spinal arteries)

- Urinary retention

When only penetrating branches are involved, long tract damage may be selective and sensory loss may be minor. Spinal cord ischaemia due to aortic atheroma evolves slowly and preferentially affects anterior horn cells. A pure conus syndrome (page 380) occasionally occurs.

Investigative approach

- Exclude other causes of acute para/quadriplegia - cord compression. Guillain Barré syndrome - by appropriate imaging or neurophysiology

- Confirm spinal ischaemia by MRI (T2 weighted imaging showing hyperintense signal changes)

- Explore possible sources of spinal ischaemia

Small vessel diseases diabetes - random or fasting blood glucose vasculitis - see pages 261-263 neurosyphilis - CSF VDRL and Captia G

endarteritis secondary to - CSF meningeal infection or granulomatous disease aortic (large) vessel diseases atheromatous - vascular risk factor e.g. cholesterol embolic - echocardiography, blood cultures thrombotic - coagulation screen dissection/aneurysm - transoesophageal echo (TOE) angiography hypotension - ECG, cardiac enzymes

Treatment is symptomatic and the outcome variable.

Posterior spinal artery syndrome

This is rare as white matter structures are less vulnerable to ischaemia. The dorsal columns are damaged and ischaemia may extend into the posterior horns.

Clinical features'. - Loss of tendon reflexes/motor weakness

- Loss of joint position sense. Venous infarction

A rapid 'total' cord syndrome with poor outcome often associated with pelvic sepsis.

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