Spinal cord infarction (SCI) is an ailment that is precipitated by the occlusion of one of the arteries of the spinal vasculature, leading to variable clinical features depending on the affected vessel. Resultant local ischemia of the spinal cord leads to the acute onset of myelopathy [1]. The latter is characterized by sensory and motor deficits below the lesion. Diagnosis of SCI is clinical, and although the condition is abrupt, it may be partially diminished and delayed due to the continued circulation provided by collateral vessels [2]. Individuals who suffer from SCI may have risk factors such as trauma, coagulopathies or prior aortic surgery, although a significant number of cases have no identifiable etiology [3] [4].

One of the most common symptoms is back pain, which occurs in up to 70% of cases [5]. The general findings reported, however, are neurological, and may include loss of fine touch and proprioception (commonly in anterior spinal artery infarcts), vibration, pain and temperature perception. Motor disturbances and flaccid paralysis have also been described. In addition, muscle weakness and loss of reflexes are often experienced [6]. Features of Brown-Sequard syndrome are also documented [7].

Individuals may also present with loss of sphincter tone as well as complaints consistent with a neurogenic bladder. Hyperreflexia may follow initial symptoms, and a positive Babinski reflex may be elicited.

SCI shares feature with other neuropathies and myopathies such as Guillain-Barré syndrome, thus making the diagnosis more difficult [1].

• Pain

  Symptoms include sudden and severe back pain, followed immediately by rapidly progressive bilateral flaccid limb weakness and loss of sensation, particularly for pain and temperature. Diagnosis is by MRI. Treatment is generally supportive. [msdmanuals.com]

  1558 1558 Emergencies in the Pain Clinic 1565 1565 Pain Management in the Emergency Department 1576 1576 Pain Management in the Intensive Care Unit 1587 An Epilogue 1602 Opioid Policy Availability and Access in Developing 1605 Complex Regional Pain Syndrome [books.google.com]

  Pseudoangina, mimicking the pain of coronary ischemia, is a non-cardiogenic chest pain. [ceemjournal.org]

  Symptoms, which generally appear within minutes or a few hours of the infarction, may include intermittent sharp or burning back pain, aching pain down through the legs, weakness in the legs, paralysis, loss of deep tendon reflexes, loss of pain and temperature [ninds.nih.gov]

• Weakness

  Gray matter has increased susceptibility to ischemia compared with white matter, producing flaccid weakness in the cervical region with isolated arm weakness. Although uncommon, cocaine abuse can cause spinal cord infarction. [ncbi.nlm.nih.gov]

  Physical and occupational therapy may help individuals recover from weakness or paralysis. A catheter may be necessary for patients with urinary incontinence. [ninds.nih.gov]

  Symptoms include sudden and severe back pain, followed immediately by rapidly progressive bilateral flaccid limb weakness and loss of sensation, particularly for pain and temperature. Diagnosis is by MRI. Treatment is generally supportive. [msdmanuals.com]

• Surgical Procedure

  They happened during surgical procedures performed with epidural anesthesia, in the presence of several specific risk factors such as spinal stenosis, vascular disease, intraoperative hypotension, or the use of epinephrine in the local anesthetic solution [ncbi.nlm.nih.gov]

  Many reports exist, and these are usually of single or a few cases of spinal cord infarction occurring in context of and classed as complications of surgical procedures in which hypotension and prolonged positioning (eg, seated neurosurgical approaches [emedicine.medscape.com]

  Spinal cord infarction is most frequently caused by surgical procedures, pathologies affecting the aorta or trauma. [thieme-connect.com]

  Aortic surgical procedures may reduce vascular supply to the radicular and spinal arteries. Procedures such as thoracotomy and nephrectomy sometimes compromise intercostal or lumbar artery flow, which give rise to radicular arteries. [aibolita.com]

  Definition of the safe lower limits of aortic resection during surgical procedures on the thoracoabdominal aorta: Use of somato-sensory evoked potentials. J Am Coll Cardiol 1983 ; 2 ( 5 ): 959 – 965. 62. Reiz, S, Peter, T, Rais, O. [cambridge.org]

• Severe Pain

  Unfortunately, several weeks’ later severe pain developed in the lower extremities. Whole body MRI control showed increase of myositis changes. [thieme-connect.com]

  At the same time, patients reported severe local pain, alternating rapidly coming paraplegic syndrome and transverse spinal cord lesions, developing in several minutes or an hour. [minclinic.ru]

  There is usually severe pain at the onset and deficits can evolve over 15 min to 48 h, indicating a "spinal stroke in evolution." There could also be a symptom-free interval between the onset of pain and deficit. [annalsofian.org]

  Cervical sprain and disc rupture are associated with severe pain and muscle spasm and are more common in adults because of the reduced elasticity of supporting tissues. Pain is often referred when the brachial plexus is involved. [chiro.org]

  First, their presenting symptom is that of the sudden severe pain in the region of the spine that is affected, whereas in thrombotic and other embolic causes, this is hardly ever the case. [radiologykey.com]

• Unable to Stand

  Although the patient could stand on her left leg, she was unable to stand on her right leg. She received continuous bladder catheterization, and her defecation was controlled by drugs. [jaclinicalreports.springeropen.com]

• Thrombosis

  thrombotic (bland) (multiple) (progressive) (silent) (vessel) I82.90 ICD-10-CM Diagnosis Code I82.90 Acute embolism and thrombosis of unspecified vein 2016 2017 2018 2019 Billable/Specific Code Applicable To Embolism of vein NOS Thrombosis (vein) NOS [icd10data.com]

  Polycythemia vera creates a high risk of systemic thrombosis due to hyperviscosity and platelet activation. [ncbi.nlm.nih.gov]

  Etiologies of completed strokes were diverse and included rupture and surgical repair of aortic aneurysms, aortic dissection, aortic rupture and thrombosis, global ischemia, anterior spinal artery embolism, repair and thrombosis of spinal arteriovenous [neurology.org]

  Thrombosis is an uncommon cause, and polyarteritis nodosa is a rare cause. [msdmanuals.com]

• Back Pain

  Symptoms, which generally appear within minutes or a few hours of the infarction, may include intermittent sharp or burning back pain, aching pain down through the legs, weakness in the legs, paralysis, loss of deep tendon reflexes, loss of pain and temperature [ninds.nih.gov]

  We describe a 65-year-old man who presented with sudden paraplegia and back pain of 4-days duration with sensory loss below the umbilicus and bilateral scalp necrosis. [ncbi.nlm.nih.gov]

  Symptoms include sudden and severe back pain, followed immediately by rapidly progressive bilateral flaccid limb weakness and loss of sensation, particularly for pain and temperature. Diagnosis is by MRI. Treatment is generally supportive. [msdmanuals.com]

  We report a case of a 77–year-old man who presented with chest pain and upper back pain initially, and was misdiagnosed with a myocardial infarction. [ceemjournal.org]

  Losses of pain and temperature sensation while vibration and position sense are preserved. Radiating back pain which is localized to the area of infarct.. [sci-recovery.org]

• Muscle Weakness

  After 2 minutes of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities. Within 5 minutes after the start of the procedure, the patient became quadriplegic. [omicsonline.org]

  In addition, muscle weakness and loss of reflexes are often experienced. Features of Brown-Sequard syndrome are also documented. Individuals may also present with loss of sphincter tone as well as complaints consistent with a neurogenic bladder. [symptoma.com]

  Muscle weakness in the legs can progress to a complete loss of movement (paralysis) very quickly. People might experience muscle spasms (spasticity). [brainandspine.org.uk]

  Clinical signs of spinal cord infarction include muscle weakness and paralysis with loss of reflexes. [teachmeanatomy.info]

  Limb weakness or dysesthesia indicates nerve root compression. [chiro.org]

• Low Back Pain

  SUMMARY OF BACKGROUND DATA: Diagnostic and therapeutic image-guided nerve root injection is commonly performed in the management of low back pain and sciatica. [ncbi.nlm.nih.gov]

  Spinal Cord Stimulation 1379 Motor Cortex and Deep Brain Stimulation 1392 Epidural Steroid Injections 1423 Intrathecal Drug Delivery in the Management of Pain 1437 Intradiscal Therapies for Low Back Pain 1458 SECTION F SURGICAL APPROACHES 1486 The Surgical [books.google.com]

  (sore tailbone) Compression fracture of the spine Degenerative and hereditary myelopathy Epiduritis and spinal abscess Low back pain, pain in leg, Sherman Mau diseases Lumbago, sciatica and lumbodynia Lumbar disc disease (herniated disc, bulging disc [minclinic.ru]

  Case 1 A 58-year-old gentleman presented with sudden-onset severe low back pain noted while lifting the shutter of a shop, followed by feeling of heaviness and weakness of both lower limbs. [annalsofian.org]

• Muscle Twitch

  A 48-year-old man with syncope and diffuse muscle twitches. Neurohospitalist. 2012 Jul; 2(3):107-11. PMID: 23983873; PMCID: PMC3726089. Wood BR, Klein JP, Lyons JL, Milner DA, Phillips RE, Schutten M, Folkerth RD, Ciarlini P, Henrich TJ, Johnson JA. [connects.catalyst.harvard.edu]

• Facial Pain

  Irritation to this nerve is considered to occur from mechanical irritation to the vertebral artery anywhere along its course, producing symptoms of a vasomotor nature; eg, headache, vertigo, tinnitus, nasal disturbances, facial pain, facial flushing, [chiro.org]

• Urinary Incontinence

  A catheter may be necessary for patients with urinary incontinence. Definition Spinal cord infarction is a stroke either within the spinal cord or the arteries that supply it. [ninds.nih.gov]

  A 61-year-old woman presented with the acute onset of right lower extremity paresthesias followed within 15 minutes by complete bilateral lower extremity paralysis and urinary incontinence. [ncbi.nlm.nih.gov]

  Catheterisation may be required if the patiemt has urinary incontinence. Prognosis Prognosis is variable and entirely depends on the severity of damage and how early the treatment has been started. Patients seeking early treatment recover better. [sci-recovery.org]

  When the arteria radicularis magna is affected the patient progresses to fecal and urinary incontinence, as well as motor deficit [ 9 ]. [jneuro.com]

• Stroke

  Abstract Spinal cord stroke is rare accounting for 0.3-1% of all strokes and is classified into upper (cervical) and lower (thoracolumbar) strokes. Patients present with severe deficits but later often show good functional improvement. [ncbi.nlm.nih.gov]

  stroke related psychiatric disorders, and other rare causes of stroke disorder. * A comprehensive source that thoroughly examines the neurological manifestations of stroke * A guide to highly studied topics, including stroke complications, syndromes [books.google.com]

  Karger AG, Basel Introduction Spinal cord stroke is a rare condition compared to cerebral stroke accounting for 0.3-1% of all strokes [ 1, 2, 3, 4 ]. [karger.com]

• Myelopathy

  In this case report, we discuss the probable relationship between surfing and ischemic myelopathy. [ncbi.nlm.nih.gov]

  BACKGROUND: Surfer’s myelopathy is a rare, acute, atraumatic myelopathy that occurs in novice surfers. OBJECTIVE: To review the literature and to present an illustrative case. [neurosurgerycns.wordpress.com]

• Spinal Cord Syndrome

  If the infarct is small and affects primarily tissue farthest away from an occluded artery (toward the center of the cord), a central cord syndrome is also possible (see table Spinal Cord Syndromes). [msdmanuals.com]

  The anterior spinal cord syndrome is the most common phenomenology, but here we present 2 nontraumatic spinal hemicord infarctions in elderly patients and discuss the clinical and radiological characteristics. [ncbi.nlm.nih.gov]

  Keywords: Querschnittsyndrom, Myelopathie, Myelitis, Paraplegie, Rückenmarksinfarkt transverse spinal cord syndrome, myelopathy, myelitis, paraplegia, spinal cord infarction syndrome de paraplégie, myélopathie, myélite, infarctus médullaire spinal [doi.org]

  A guide to determine the spinal cord level is below. Guide to clinical determination of the segmental spinal cord level. [emedicine.medscape.com]

  The anterior spinal artery is typically affected, resulting in the anterior cord syndrome (see table Spinal Cord Syndromes). Position and vibration sensation, conducted by the posterior columns, and often light touch are relatively spared. [merckmanuals.com]

• Flaccid Paralysis

  Motor disturbances and flaccid paralysis have also been described. In addition, muscle weakness and loss of reflexes are often experienced. Features of Brown-Sequard syndrome are also documented. [symptoma.com]

  […] factors may be present Examination Anterior spinal artery syndrome is most common: loss of motor function and pain/temperature sensation, with relative sparing of proprioception and vibratory sense below the level of lesion Initially presents with a flaccid [lifeinthefastlane.com]

  In this case, CT demonstrated no evidence of epidural collection or explanation for the flaccid paralysis. [ajnr.org]

  paralysis (paraplegia or quadriplegia according to the level of the lesion), areflexia, loss of spinothalamic sensory modalities (pain and temperature), and autonomic deficits (such as atonic urinary bladder, paralytic ileus, and abolished sphincter [clinicalgate.com]

  After sensitivity disorder in patients develops a hand muscles flaccid paralysis (peripheral type) and a leg muscles spastic paraparesis (central type) due spinal cord pyramidal tract involvement in lesion site. [minclinic.ru]

• Hyperreflexia

  Hyperreflexia may follow initial symptoms, and a positive Babinski reflex may be elicited. SCI shares feature with other neuropathies and myopathies such as Guillain-Barré syndrome, thus making the diagnosis more difficult. [symptoma.com]

  Initially areflexia is present due to spinal shock but, hyperreflexia and spasticity appear later The most common form is anterior spinal artery syndrome. [sci-recovery.org]

  Initial areflexia changes to hyperreflexia with the presence of Babinski signs. [aibolita.com]

  Within days, flaccid limbs become spastic and hyporeflexia (underactive nerve responses) turns into hyperreflexia (overactive nerve responses) and extensor plantar nerve responses. [en.wikipedia.org]

  Later on, flaccidity and areflexia give way to spasticity and hyperreflexia. [radiologykey.com]

The aim of imaging modalities and laboratory studies is to demonstrate the presence of a spinal cord infarction, and also to rule out alternative etiologies of symptoms such as hypercoagulability and stroke due to cardiac emboli.

Visualization of the spinal cord in the form of magnetic resonance imaging (MRI) scanning may show abnormalities such as the 'owl eye' sign, seen in anterior spinal artery (ASA) involvement [5]. Nevertheless, up to 45% of patients have undetectable changes on MRI while in the acute stages. Additional signs include vertebral body infarction, which may become apparent earlier than SCI [8]. The importance of MRI is emphasized in its ability to exclude conditions such as atriovenous malformations, space occupying lesions and infection [9]. Diffusion-weighted imaging and T2 weighted imaging may be able to detect early infarctions, although artifacts are common in the former [10]. Signs of cord ischemia seen in T2 weighted images include local swelling and hyperintense lesions [1] [2] [10]. Brain abnormalities may also be visible after some hours.

Spinal angiogram to eliminate vascular malformations as the cause may be attempted in young patients, however, this procedure is available at highly specialized institutions and carries a risk of worsening the ischemia.

Cerebrospinal fluid (CSF) analysis can rule out both bacterial and viral infections such as human immunodeficiency virus, herpes simplex virus, Epstein-Barr virus, and syphilis. Polymerase chain reaction and serology are among the tests performed. Screening for autoimmune causes uses both CSF and serum analysis, measuring erythrocyte sedimentation rate, antinuclear antibody, and complement.

• Spinal Cord Necrosis

  The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region. [jmedicalcasereports.biomedcentral.com]

The patient underwent hyperbaric oxygen treatment. Her symptoms and signs related to spinal cord infarction gradually remitted, and nearly complete disappearance of neurological deficits was noted within 3 months after the start of treatment. [ncbi.nlm.nih.gov]

Treatment Treatment is symptomatic. Physical and occupational therapy may help individuals recover from weakness or paralysis. A catheter may be necessary for patients with urinary incontinence. × Treatment Treatment is symptomatic. [ninds.nih.gov]

The first chapter stresses the etiology and pathophysiology of childhood stroke as the basis for evaluations and treatment. [books.google.com]

There are few reports in the pediatric literature characterizing etiology, diagnosis, treatment, and prognosis. [ncbi.nlm.nih.gov]

Definition Treatment Prognosis Clinical Trials Organizations Publications Definition Spinal cord infarction is a stroke either within the spinal cord or the arteries that supply it. [ninds.nih.gov]

Prognosis Prognosis is variable and entirely depends on the severity of damage and how early the treatment has been started. Patients seeking early treatment recover better. [sci-recovery.org]

Nine patients (40.9%) had probable etiologies, while 13 were cryptogenic (59.1%). The primary etiologies were aortic diseases. Hypertension was the most common vascular risk factor (50%). [ncbi.nlm.nih.gov]

The first chapter stresses the etiology and pathophysiology of childhood stroke as the basis for evaluations and treatment. [books.google.com]

Individuals who suffer from SCI may have risk factors such as trauma, coagulopathies or prior aortic surgery, although a significant number of cases have no identifiable etiology. [symptoma.com]

A comprehensive summary of the clinical anatomy, patho-physiologic mechanisms, epidemiology, diagnosis and treatment of FCE is described, along with the conflicting opinions on its incidence and relevance after reviewing all of the related literature. [ncbi.nlm.nih.gov]

Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [mdedge.com]

However, no epidemiologic studies are available because of the relatively small number of patients affected. [emedicine.medscape.com]

Nontraumatic spinal cord injury: incidence, epidemiology and functional outcome Arch Phys Med Rehabil 1999 80 : 619–623 32 Hirono H et al. [nature.com]

Thoracic myelopathy in Japan epidemiological retrospective study in Miyagi Prefecture during 15 years. Tohoku J Exp Med. 2006;210(3):199–208. View Article PubMed Google Scholar Copyright [jaclinicalreports.springeropen.com]

In the majority of these cases, the pathophysiology is enigmatic. The authors present 3 cases of pediatric spinal cord infarction that followed minor trauma. [ncbi.nlm.nih.gov]

The first chapter stresses the etiology and pathophysiology of childhood stroke as the basis for evaluations and treatment. [books.google.com]

We wish to review the relevant anatomical, clinical and diagnostic characteristics along with current techniques of spinal cord ischemia prevention during and after surgery. [ncbi.nlm.nih.gov]

Identification of risk factors and interventions to prevent and treat spinal cord ischemia has the potential to prevent spinal cord infarction and the morbidity and mortality associated with paraplegia. [doi.org]

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2. Weidauer S, Nichtweiss M, Lanfermann H, Zanella FE. Spinal cord infarction: MR imaging and clinical features in 16 cases. Neuroradiology. 2002;44(10):851–857.
3. Masson C, Pruvo JP, Meder JF, et al. Spinal cord infarction: clinical and magnetic resonance imaging findings and short term outcome. J Neurol Neurosurg Psychiatry. 2004;75(10):1431–1435.
4. Nedeltchev K, Loher TJ, Stepper F, et al. Long-term outcome of acute spinal cord ischemia syndrome. Stroke. 2004;35(2):560–565.
5. Cheng MY, Lyu RK, Chang YJ, et al. Spinal cord infarction in Chinese patients. Clinical features, risk factors, imaging and prognosis. Cerebrovasc Dis. 2008;26(5):502–508.
6. Mascalchi M, Cosottini M, Ferrito G, Salvi F, Nencini P, Quilici N. Posterior spinal artery infarct. AJNR Am J Neuroradiol. 1998;19(2):361–363.
7. Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol. 2006;63(8):1113–1120.
8. Suzuki T, Kawaguchi S, Takebayashi T, Yokogushi K, Takada J, Yamashita T. Vertebral body ischemia in the posterior spinal artery syndrome: case report and review of the literature. Spine (Phila Pa 1976). 2003;28(13):E260–4.
9. Bammer R, Fazekas F, Augustin M, et al. Diffusion-weighted MR imaging of the spinal cord. AJNR Am J Neuroradiol. 2000;21(3):587–591.
10. Thurnher MM, Bammer R. Diffusion-weighted MR imaging (DWI) in spinal cord ischemia. Neuroradiology. 2006;48(11):795–801.