Spinal infarction : It is the result of ischemia that originates from an extravertebral artery. Symptoms include sudden, severe back pain, followed immediately by rapidly progressive bilateral flaccid weakness of the extremities and loss of sensation, especially for thermoalgesia.
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- 1 Peculiarities of spinal cord infarction
- 1 Signs and symptoms
- 2 Location
- 3 Diagnosis
- 4 Forecast
- 5 Treatment
- 2 Aetiopathogenesis of spinal cord infarction
- 3 Sources
Peculiarities of spinal infarction
Signs and symptoms
Sudden back pain with oppression that radiates circumferentially is followed within minutes by flaccid weakness and loss of sensation. Thermoalgesic sensitivity is disproportionately affected . The anterior spinal artery is usually affected , leading to spinal syndrome .
The sensation of position and vibration, driven by the posterior columns, and often light touch, are relatively preserved. If the infarction is small and primarily affects the tissue furthest from the occluded artery (towards the center of the medulla), the appearance of a central spinal syndrome is also possible. Neurological deficits can partially resolve after a few days.
Most medullary infarcts occur in the territory vascularized by the anterior spinal artery, thus affecting the two anterior thirds of the medulla. The lower thoracic and upper lumbar levels are the most commonly affected, followed by the mid thoracic levels. The lower cervical cord is more infrequently affected, although it varies according to the series, but in any case, what is remarkable is what we have already mentioned, and that is that heart attacks at the cervical level are more frequent than expected due to the usually rich arrival of afferent, due to the existence of fewer anastomoses that make each territory dependent on a single artery. High chest levels are rarely affected by ischemia.
A nuclear magnetic resonance (NMR) is performed or, if not available, a melography. These tests help rule out other disorders that cause similar symptoms. A lumbar puncture is performed to rule out transverse myelitis as the cause of the symptoms. Angiography confirms that an artery in the anterior region of the spinal cord is blocked, but is usually not necessary.
It is bad, although there may be complete recovery in the first month and for 1 year, depending on the degree of parenchymal damage. The longer duration of the maximum deficit worsens the prognosis, which is better if there is a significant improvement in the first 24 hours. Also the greater severity of said maximum deficit worsens the prognosis. Approximately 50% of patients regain gait requiring only support and without the need for bladder catheterization (Masson, 2004)
- Treatment of the cause whenever possible
- Relief of symptoms
Where possible, the cause is treated (such as aortic dissection or polyarteritis nodosa), but if not, treatment focuses on relieving symptoms and managing complications, because paralysis and spinal cord dysfunction are often permanent. Since some sensations are lost and paralysis can develop, it is important to avoid pressure ulcer formation. Therapy may be necessary to help evacuate secretions from the lungs (such as deep breathing exercises, postural drainage, and aspiration). The physiotherapy and occupational therapy(See Physiotherapy (FT)) can help preserve muscle function. Because the functioning of the bladder is usually impaired, a tube is needed to evacuate the urine. This treatment prevents the bladder from enlarging and being damaged.
Spinal cord infarction etiopathogenesis
Blocking an artery that carries blood to the spinal cord prevents blood, and therefore oxygen, from reaching it. As a result, the spinal tissues die (heart attack).
- Causes include severe atherosclerosis, inflammation of the blood vessels, bloodclots, and sometimes procedures that somehow affect the abdominal aorta.
- Sudden back pain occurs with pain radiating from the affected area, followed by muscle weakness and an inability to feel heat, cold, and pain in the affected areas, and sometimes paralysis.
- An MRI or myelogram is usually done.
- Treatment is aimed at correcting the cause if possible or relieving symptoms.
- Spinal cord dysfunction and paralysis are usually permanent.
Like all body tissues, the spinal cord requires a constant supply of oxygenated blood. Only a few arteries, which are branches of the aorta, supply blood to the anterior part of the spinal cord, but this blood accounts for three quarters of the total blood received by the cord. Therefore, the blockage of any of these arteries is very serious. This type of blockage is due in some cases to:
- Severe atherosclerosisof the aorta (see Atherosclerosis).
- Separation of the layers of the wall of the aorta (aortic dissection, see Aortic dissection).
- Inflammation of the blood vessels(vasculitis, see Introduction to vasculitis), such as polyarteritis nodosa.
- A blood clot that breaks loose from the heartwall and travels through the bloodstream (becoming an embolus).
- Procedures that act on the abdominal aorta, such as surgeryto repair a dilation (aneurysm) in it.