Spinal Cord Infarction: Clinical and Radiological Features

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Abstract

Introduction: Spinal cord infarction is an uncommon disease varying in its clinical presentation. This study describes the clinical and radiological presentation of spinal cord infarcts in 17 consecutive patients. Material and Methods: Clinical and MR imaging data of 17 patients were reviewed. Inclusion criteria were acute or subacute presentation (peak within 72 hours) and MRI showing typical signal changes on T2WI compatible with spinal cord infarct. Exclusion criteria were clinical or MRI findings suggesting other etiologies. Results: Clinical presentation included dissociative anesthesia, weakness of limbs, back or neck pain, and autonomic symptoms with symptom onset to peak time ranging from few minutes to 48 hours in patients with anterior spinal artery infarct (n = 16), and weakness and sensory loss in ipsilateral upper limb in patient with posterior spinal artery infarct (n = 1). One patient presented with “man-in-the-barrel syndrome (MIB).” MRI findings in anterior spinal artery infarcts included pencillike hyperintensities on T2 sagittal (n = 16, 100%) and “owl eye” appearance on T2 axial (n = 6, 37.5%) images. Diffusion restriction was noted in 8 cases and enhancement was noted in 2 cases. The posterior spinal artery infarct showed T2 hyperintensity in left posterior paramedian triangular distribution in cervical cord (C2-C7). Follow-up was available for 9 patients (period ranging from 15-41 months). Four patients had a favorable outcome who could walk independently, 1 patient could walk with support, and 2 patients were wheelchair bound. Two patients died. Conclusion: Spinal cord infarction is a rare but important cause of acute spinal syndrome. Typical distribution and appropriate imaging can help in timely diagnosis.

Section snippets

Methods

This retrospective observational study was performed at a tertiary referral center in southern India. Patients who presented to our institute with signs and symptoms of SCI over a period of 4 years (March 2013 to March 2017) were included.

Results

There were 11 male and 6 female patients, age ranging from 12 years to 87 years (mean age 32.6 years). Symptom onset to peak time ranged from few minutes to 48 hours. The clinical symptoms are summarized in Table 1. There were 16 patients with ASA infarct and 1 patient with PSA infarct. All 16 patients with ASA infarct presented dissociative anesthesia (n = 16, 100%), and weakness of limbs (n = 16, 100%) upper/lower was noted depending on the level of lesion in the cord. Back pain and neck pain

Discussion

Spinal cord has an intricate network of blood supply. Various texts and articles describe the anatomy in exquisite details.11, 12, 13, 14, 15

Patients with SCI develop symptoms quickly with maximal symptomatology reached within 12 hours for 50% of patients and within 72 hours for most patients.16 The symptom onset to peak time ranged from few minutes to 48 hours in our study. All 16 patients with ASA infarct in our study presented with dissociative anesthesia and weakness of upper limbs/lower

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