Spinal cord infarction

Classification according to ICD-10
G95.1	Vascular myelopathies
ICD-10 online (WHO version 2019)

Under spinal cord infarction refers to a damage of the spinal cord as a result of oxygen deficiency due to insufficient blood flow. Spinal shock is an extreme form .

distribution

Spinal cord infarctions are rare and account for only 1% of all infarcts.

root cause

Cross section through the spinal cord. The structure marked with 6 is the anterior spinal artery, with 5 the two posterior spinal arteries are marked.

The spinal cord is supplied on the ventral side (ventral) by the anterior spinal artery . On the back (dorsal), the posterior spinal artery is created in pairs and is therefore less endangered. The blood supply to these arteries can be restricted by arteriosclerosis or embolism . A specialty are fibro-cartilage embolisms from the intervertebral discs in young, sporty patients or pregnant women as well as in domestic dogs (→ fibro-cartilaginous embolism ). Vascular malformations such as arterio-venous dural fistulas can also lead to infarction.

Obligations of the arteries by tumors , aortic aneurysm or aortic dissection are more common . Furthermore, involvement of the spinal vessels in vasculitis can be the cause of infarcts.

In the thoracic region , the supply by the Adamkiewicz artery ( arteria radicularis magna ), which usually arises from the aorta at the level of the 9th to 12th breast segment, is decisive for the blood supply to the spinal arteries. Because of the variable position of this artery, infarctions are a dreaded complication in operations on the aorta in the thorax.

Clinical manifestations

Spinal cord infarction presents itself differently depending on the arteries affected. The anterior spinal artery syndrome and the posterior spinal artery syndrome are a combination of pain, sensory disturbances and paralysis that usually occur suddenly.

Investigation methods

The most accurate examination method is magnetic resonance imaging . Unfortunately, not all patients can be reliably diagnosed with this method either. In one study, only 67% of all spinal cord infarctions could be detected with the MRI. The computed tomography is also used to vascular malformations and compression of the spinal cord can be seen as a differential diagnosis. The vessels can also be shown well using digital subtraction angiography . A lumbar puncture can be used to identify inflammatory causes.

treatment

Treatment depends on the cause. A spinal cord infarction should always be viewed as an emergency because there is a time window for successful treatment before the spinal cord is irreversibly damaged. The acute treatment should be followed by rehabilitation . One study showed complete or near complete healing in 70% of patients.

Literature and Sources

1. ↑ Sandson TA, Friedman JH: Spinal cord infarction. Report of 8 cases and review of the literature . In: Medicine (Baltimore) . 68, No. 5, September 1989, pp. 282-92. PMID 2677596 .
2. ↑ Ch.W. Hess: Non-Traumatic Acute Paraplegic Syndromes . (PDF) In: PRAXIS . No. 94, 2005, pp. 1151-1159. doi : 10.1024 / 0369-8394.94.30.1151 .  ( Page no longer available , search in web archives )
3. ^ ^{A b c d} Robert P. Lisak, Daniel Truong, William K. Carroll, Roongroj Bhidayasiri: International Neurology . Wiley-Blackwell,, ISBN 978-1-4051-5738-4 , p. 42.
4. ^ Walter Gehlen: Neurology . Thieme Georg Verlag ,, ISBN 3-13-129771-9 , p. 363.
5. ↑ Sinha AC, Cheung AT: Spinal cord protection and thoracic aortic surgery . In: Curr Opin Anaesthesiol . 23, No. 1, February 2010, pp. 95-102. doi : 10.1097 / ACO.0b013e3283348975 . PMID 19920758 .
6. ↑ ^{a b} Peter Schwenkreis, Pennekamp, ​​Werner; Tegenthoff, Martin: Differential diagnosis of acute and subacute non- traumatic paraplegia . In: Deutsches Ärzteblatt . 103, No. 44, March 15, 2006, p. 2954.

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