Spinal cord infarction (ischemic myelopathy)

Spinal cord infarction is usually caused by damage to the extarvertebral arteries. Symptoms include sudden and severe back pain, bilateral flaccid paresis of the limbs, a decrease in sensitivity, in particular pain and temperature. It is diagnosed by means of MRI. Treatment in most cases is symptomatic.

Blood supply to the posterior third of the spinal cord is provided by the posterior spinal artery, the anterior two-thirds by the anterior spinal artery. The anterior spinal artery has several arteries in the upper cervical region and one large artery-bearing artery (Adamkiewicz artery) in the lower thoracic region. Those who bring arthritis depart from the aorta. Since the collateral blood supply of the basin of the anterior cerebral artery is scattered, there are segments of the spinal cord (for example, from the 2nd to 4th thoracic segments) that are particularly sensitive to ischemia. Damage to extrovertebral arteries or aorta (for example, atherosclerosis, dissection, prolonged clamping during surgery) causes a heart attack more often than the defeat of the spinal arteries proper. Thrombosis is an infrequent cause, nodular polyarteritis is rare.

Sudden back pain with girdle irradiation and sensation of the constrictor belt, followed by segmental bilateral weakness of the muscles and sensory disorders. Pain and temperature sensitivity decrease disproportionately, the most common lesion is the anterior spinal artery causing the anterior spinal syndrome. Positional and vibration sensitivity transmitted over the posterior columns, and often tactile sensitivity is relatively preserved. If the infarction is small and the tissues are at the greatest distance from the occluded artery, the development of central spinal cord syndrome is possible. The neurologic deficit may partially regress within the first few days.

Infarction can be suspected of acute back pain combined with a characteristic neurological deficit. Diagnosis requires an MRI. Acute transverse myelitis, spinal cord compression and demyelinating diseases can cause similar clinical symptoms, which tend to develop gradually and are excluded by MRI and spinal fluid analysis. Occasionally, the causes of a heart attack can be curable (for example, dissection of the aorta, nodular polyarteritis), but most often symptomatic (supportive) treatment.

Spinal Cord Syndromes

Syndrome	Cause	Symptoms
Anterior spinal cord syndrome	The defeat of the spinal cord is disproportionate to the lesion of the anterior spinal artery, usually caused by occlusion of the anterior spinal artery before the infarction.	The tendency to dysfunction of all tracts with the exception of the posterior columns, with the preservation of positional and vibration sensitivity
Central spinal cord syndrome	The defeat of the central parts of the spinal cord, mainly the central gray matter and crossed spinal-thalamic tracts; usually caused by trauma, syringomyelia and a tumor of the central parts of the spinal cord	Paresis with greater severity in the upper than in the lower extremities and sacral regions; the tendency to reduce the pain and temperature sensitivity by the type of jacket, extending to the neck, shoulder and lower body, with relative safety of tactile, positional and vibration sensitivity (dissociated sensitivity disorder)
Syndrome of the cone of the spinal cord	The lesion in the T12-vertebra	Distal paresis of the legs, decreased sensitivity in the perianal area, erectile dysfunction, urinary retention, anal sphincter hypotension
Transverse myelopathy	The defeat of the entire diameter of the spinal cord for at least one segment	Decrease in all functions of the spinal cord (since all tracts are affected to varying degrees)
Syndrome Brown-Sekar (rare)	Half (one-sided) spinal cord injury, usually due to penetrating trauma	Ipsilateral paresis, ipsilateral loss of tactile, positional, vibration sensitivity, contralateral - loss of pain and temperature sensitivity (partial Brown-Sekar syndrome is possible)

[1], [2], [3], [4], [5], [6], [7], [8], [9]