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.
Subscribers log in hereLiterature review current through: Nov 2017. | This topic last updated: Jun 21, 2017.References
- Restrepo L, Guttin JF. Acute spinal cord ischemia during aortography treated with intravenous thrombolytic therapy. Tex Heart Inst J 2006; 33:74.
- Baba H, Tomita K, Kawagishi T, Imura S. Anterior spinal artery syndrome. Int Orthop 1993; 17:353.
- Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation 2007; 115:e478.
- Cheung AT, Weiss SJ, McGarvey ML, et al. Interventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction. Ann Thorac Surg 2002; 74:413.
- Cheung AT, Pochettino A, McGarvey ML, et al. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms. Ann Thorac Surg 2005; 80:1280.
- McGarvey ML, Mullen MT, Woo EY, et al. The treatment of spinal cord ischemia following thoracic endovascular aortic repair. Neurocrit Care 2007; 6:35.
- McGarvey ML, Cheung AT, Szeto W, Messe SR. Management of neurologic complications of thoracic aortic surgery. J Clin Neurophysiol 2007; 24:336.
- Hurst, RW. Spinal vascular disorders. In: Magnetic Resonance Imaging of the Brain and Spine 2nd Edition, Atlas, SW (Ed), Lippincott, Philadelphia 2006. p.1387.
- Van Dijk JM, TerBrugge KG, Willinsky RA, et al. Multidisciplinary management of spinal dural arteriovenous fistulas: clinical presentation and long-term follow-up in 49 patients. Stroke 2002; 33:1578.
- Cheshire WP, Santos CC, Massey EW, Howard JF Jr. Spinal cord infarction: etiology and outcome. Neurology 1996; 47:321.
- Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol 2006; 63:1113.
- 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; 75:1431.
- Robertson CE, Brown RD Jr, Wijdicks EF, Rabinstein AA. Recovery after spinal cord infarcts: long-term outcome in 115 patients. Neurology 2012; 78:114.
- Latoś T, Markiewicz R, Gaszczyk G. [Spirographic studies and measurement of airflow resistance in evaluation of bronchial hyperreactivity in children with asthma]. Pneumonol Pol 1990; 58:107.
- Nedeltchev K, Loher TJ, Stepper F, et al. Long-term outcome of acute spinal cord ischemia syndrome. Stroke 2004; 35:560.
- Salvador de la Barrera S, Barca-Buyo A, Montoto-Marqués A, et al. Spinal cord infarction: prognosis and recovery in a series of 36 patients. Spinal Cord 2001; 39:520.
- Iseli E, Cavigelli A, Dietz V, Curt A. Prognosis and recovery in ischaemic and traumatic spinal cord injury: clinical and electrophysiological evaluation. J Neurol Neurosurg Psychiatry 1999; 67:567.
- Geldmacher DS, Bowen BC. Vascular Disease of the Nervous System. In: Neurology in Clinical Practice, 4th, Bradley WG, Daroff RB, Fenichel GM, Jankovic J (Eds), Butterworth Heinemann, Philadelphia 2004. p.1313.
- Cheng MY, Lyu RK, Chang YJ, et al. Spinal cord infarction in Chinese patients. Clinical features, risk factors, imaging and prognosis. Cerebrovasc Dis 2008; 26:502.
- 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
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS