Spinal cord infarction: Prognosis and treatment
- 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 disorder caused by a wide variety of pathologies. Patients typically present with acute paraparesis or quadriparesis depending on the level of the spinal cord involved. The severity can vary, and while many patients make some functional recovery, permanent and disabling neurologic deficits remain in most. Specific treatment options are unfortunately limited.
This topic discusses the prognosis and acute treatment of spinal cord infarction. The causes, clinical symptoms, and diagnosis of spinal cord infarction are discussed separately. The management of chronic complications of spinal cord infarction is also discussed separately. (See "Spinal cord infarction: Vascular anatomy and etiologies" and "Spinal cord infarction: Clinical presentation and diagnosis" and "Disorders affecting the spinal cord" and "Chronic complications of spinal cord injury and disease".)
General medical care — Depending on the level and severity of spinal cord ischemia, patients are at risk for a number of systemic as well as neurologic complications in the first days and weeks. Some of these are potentially life-threatening and can exacerbate the neurologic injury. Early intervention can avoid and ameliorate many of these. Patients with moderate to severe deficits resulting from a high thoracic or cervical cord infarct should be admitted to an intensive care unit with close monitoring of vital signs and neurologic status.
Cardiovascular complications — Neurogenic shock refers to hypotension, usually with bradycardia, attributed to interruption of autonomic pathways in the spinal cord causing decreased vascular resistance. Patients with spinal cord infarction may also have hemodynamic instability related to the underlying etiology. An adequate blood pressure is believed to be critical in maintaining adequate perfusion to the ischemic, but not yet infarcted, spinal cord.
Bradycardia can occur in severe, high cervical (C1 through C5) lesions and may require external pacing or administration of atropine.
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- General medical care
- - Cardiovascular complications
- - Respiratory complications
- - Venous thromboembolism and pulmonary embolism
- - Pressure sores
- - Urinary catheterization
- - Gastrointestinal stress ulceration
- - Temperature control
- - Functional recovery
- Specific treatments
- - Thrombolysis
- - Corticosteroids
- - Following aortic surgery or endovascular repair
- - Other underlying cause
- SUMMARY AND RECOMMENDATIONS