Spinal cord infarction is a rare vascular-occlusive disorder of the spinal cord that constitutes only 1% of reported strokes. It is characterized by myelopathy and sensory loss, although atypical symptoms occur.
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 . 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 . 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  .
One of the most common symptoms is back pain, which occurs in up to 70% of cases . 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 . 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. Hyperreflexia may follow initial symptoms, and a positive Babinski reflex may be elicited.
Entire Body System
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]
Intravenous administration of steroids in high doses was ineffective and unfortunately the patient has remained severely impaired since then. [ncbi.nlm.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, 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]
Infarction is suspected when severe back pain and characteristic deficits develop suddenly. Diagnosis of spinal cord infarction is by MRI. [merckmanuals.com]
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]
Morquio syndrome, or mucopolysaccharidosis type IV, is a rare enzyme deficiency disorder and results in skeletal dysplasia. Odontoid dysplasia is common among affected patients, resulting in atlantoaxial instability and spinal cord compression. [ncbi.nlm.nih.gov]
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]
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]
Electrical stimulation of cardiopulmonary afferent fibers excites spinothalamic tract cells in the T1 to T6 segments of the spinal cord. [ncbi.nlm.nih.gov]
"This abundant supply of flexor-reflex afferent impulses excites the alpha motor neurons through multisynaptic connections causing an excess of excitation of paravertebral muscles resulting in spasm." [chiro.org]
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
Physical examination revealed flaccid paresis of the upper extremities. Spasticity at 2 mos after injury, but no detectable weakness, developed in the lower extremities. Cocaine was detected in her urine. [ncbi.nlm.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]
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]
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]
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 . 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 . The importance of MRI is emphasized in its ability to exclude conditions such as atriovenous malformations, space occupying lesions and infection . Diffusion-weighted imaging and T2 weighted imaging may be able to detect early infarctions, although artifacts are common in the former . Signs of cord ischemia seen in T2 weighted images include local swelling and hyperintense lesions   . 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.
- 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.
- 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.
- 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.
- Nedeltchev K, Loher TJ, Stepper F, et al. Long-term outcome of acute spinal cord ischemia syndrome. Stroke. 2004;35(2):560–565.
- 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.
- 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.
- 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.
- 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.
- 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.
- Thurnher MM, Bammer R. Diffusion-weighted MR imaging (DWI) in spinal cord ischemia. Neuroradiology. 2006;48(11):795–801.