Spinal cord ischemia

Clinical imaging patterns, pathogenesis and outcomes in27 patients. Novy J et al. Arch Neurol 2006; Bogousslavsky types spinal cord infarcts based on clinical findings and vascular anatomy. 27 patients were studied. Two had TIA's (one repetitive TIAs while gardening-- mechanical stress). There were 6 syndromes 1) anterior spinal artery (10) produced a bilateral motor deficit with spinothalamic sensory deficit 2) anterior unilateral infarct occurred hemiparesis with contralateral ST deficit(4) 3 posterior unilateral infarct caused HP with ipsilateral meniscal sensory loss4 4) central cord infarct caused bilateral STT deficit without motor infarct3 5) posterior spinal artery infarct-- bilateral motor deficit with lemniscal sensory loss2 6) transverse infarct bilateral motor and complete sensory infarct.2 20 were idiopathic, three were associated with prolonged arterial hypotension just before infarction, and 3 had associated mechanical causes especially disc rupture. Of type 1, the most common type, 7 had chronic spinal disease and 6 had a sudden triggering movement. Anterior unilateral and posterior spinal artery had underlying spinal disease and triggering movements also. By contrast, central and transverse infarcts were more likely to be associated with hypotension. With mechanical stress, the most common lesion was of the radicular arteries. Initial pain was expected, with one patient developing C8 radiculopathy. Vertebral body infarcts occassionally occurred. Another syndrome reported in JNNP (1996) was fibrocartilaginous emboli after spine movement that presented with pain only, then progressive irreversible evolution and is always lethal. The prognosis was good in most patients.