Spinal cord infarction: Vascular anatomy and etiologies
- Michael T Mullen, MD
Michael T Mullen, MD
- Assistant Professor of Neurology
- University of Pennsylvania School of Medicine
- Michael L McGarvey, MD
Michael L McGarvey, MD
- Associate Professor of Neurology
- University of Pennsylvania School of Medicine
Spinal cord infarction is a rare but often devastating disorder caused by a wide array of pathologic states. Patients typically present with acute paraparesis or quadriparesis, depending on the level of the spinal cord involved. The diagnosis is generally made clinically, with neuroimaging to confirm the diagnosis and exclude other conditions.
This topic discusses the vascular anatomy of the spinal cord as well as the epidemiology and causes of spinal cord infarction. The clinical features, diagnosis, prognosis, treatment and chronic complications of spinal cord infarction are discussed separately. Other causes of myelopathy are also discussed separately. (See "Spinal cord infarction: Clinical presentation and diagnosis" and "Spinal cord infarction: Prognosis and treatment" and "Chronic complications of spinal cord injury and disease" and "Disorders affecting the spinal cord" and "Anatomy and localization of spinal cord disorders".)
The incidence of spinal cord infarction has not been specifically reported. It has been estimated that spinal cord infarction accounts for approximately 1 percent of all strokes [1,2]. Extrapolating from estimates of total stroke incidence in the United States, which range from 540,000 to 780,000 per year, it is expected that 5000 to 8000 cases of spontaneous spinal cord infarction occur per year [3,4]. This may be an underestimate, as these figures likely do not include spinal cord infarction complicating major surgery, which is the most common cause of spinal cord infarction.
Spinal cord infarction typically occurs in adults; this is expected as it is usually a direct or indirect complication of atherosclerotic vascular disease; in one series, the mean age was 64 years . However, children, even neonates, can develop spinal cord infarction in specific circumstances (see 'Etiologies' below) .
Three major vessels arising from the vertebral arteries in the neck supply the spinal cord (figure 1) . There is one anterior spinal artery (ASA) and a pair of posterior spinal arteries (PSA). The ASA supplies the anterior two-thirds of the spinal cord. The ASA and PSAs anastomose distally at the conus medullaris .
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- VASCULAR ANATOMY
- Anterior spinal artery
- Posterior spinal artery
- Venous system
- Factors that modulate blood flow
- Aortic surgery
- Aortic dissection
- Other aortic pathologies
- Nonaortic surgeries
- Fibrocartilaginous embolism
- Systemic hypotension
- Vascular malformation
- Other causes
- SUMMARY AND RECOMMENDATIONS