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].

• 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]

• Back Pain

  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. [merckmanuals.com]

  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 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]

• 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]

• 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]

• Hematuria

  There was no hematuria or proteinuria to suggest renal involvement. Nerve conduction studies were noncontributory. Considering the high specificity of cANCA, the possibility of immune-mediated disease with SCI was considered. [annalsofian.org]

• Bladder Distention

  Quadriparesis evolved within 2 h and bladder distention was subsequently noted. On examination, the sensorium was preserved. Tone was decreased in all four limbs, power was grade 2 in the upper limbs and grade 3 in the lower limbs. [annalsofian.org]

• Myelopathy

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

  B.A....Benzel E.C. 2017 23 Intensive Gait Treatment Using a Robot Suit Hybrid Assistive Limb in Acute Spinal Cord Infarction: Report of Two Cases. ( 28990874 ) Watanabe H....Matsumura A. 2017 24 Letter: Surfer's Myelopathy: A Rare Form of Spinal Cord [malacards.org]

  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]

• 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]

• Radiculomyelopathy

  Rivista di Neuroradiologia 17(3):277–281 Google Scholar Thron A, Koenig E, Pfeiffer P, Rossberg C (1987) Dural vascular anomalies of the spine-an important cause of progressive radiculomyelopathy. [link.springer.com]

• Upper Extremity Spasticity

  The patient seems to have an infarct in the anterior spinal artery distribution, with clinical, imaging, and electrodiagnostic findings of upper-extremity lower-motor neuron injury, accompanied by spasticity of the lower extremities. [ncbi.nlm.nih.gov]

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.

• Hyperviscosity

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

• Streptococcus Pneumoniae

  Abstract We report a male with spinal cord infarction and tetraplegia after Streptococcus pneumoniae meningitis. He was subsequently found to have both a Chiari I malformation and factor V Leiden mutation. [ncbi.nlm.nih.gov]

• 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]

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]

Conclusion: Acute spinal cord ischemia syndrome has a severe prognosis with permanent and disabling sequelae. [nature.com]

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]

1. de Seze J, Stojkovic T, Breteau G, et al. Acute myelopathies: Clinical, laboratory and outcome profiles in 79 cases. Brain. 2001;124(Pt 8):1509–1521.
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.