Global ischaemia secondary to low cardiac output (cardiac arrest, severe hypotension in a context of shock, etc.). In this case, ischaemia predominantly affects the grey matter (central region) and thoracolumbar territory (less vascularized zones);

Focal ischaemia in the territory of an artery supplying the spinal cord, most commonly in the territory of the artery of Adamkiewicz. In this case, ischaemia predominantly affects the anterior two-thirds of the spinal cord, while sparing the posterior columns.

Spinal cord infarction is very rare compared to cerebral infarction due to the small dimensions of the spinal cord, the abundance of arterial anastomoses and the low incidence of atherosclerosis of spinal arteries.

Clinical symptoms are very variable, depending on the level and depth of ischaemia.

Neurological disorders with sudden or very rapidly progressive onset, often preceded by back pain. Very rarely, some patients report previous episodes of transient neurological deficits (spinal cord TIA).

Most classical clinical presentation: anterior spinal syndrome characterized by sudden onset of painful paraparesis or tetraparesis with sensory deficit for pain and temperature below the lesion, sphincter disorders and relative sparing of deep sensation. The level of the lesion is usually cervicothoracic or thoracolumbar (due to the anatomical arrangement of the blood supply). Differential diagnosis with transverse myelitis can sometimes be difficult. Imaging is useful to differentiate between the two entities. Possibility of incomplete Brown-Séquard syndrome (hemiparesis ipsilateral to the lesion and contralateral pain and temperature sensory deficit with sparing of deep sensation in this context) in case of unilateral involvement.

Posterior spinal syndrome is much rarer due to the extensive anastomotic networks. Generally bilateral involvement, responsible for paraesthesia and disorders of deep sensation, sometimes with motor and spinothalamic involvement in the case of anterior extension. If unilateral involvement (rare), incomplete Brown-Séquard syndrome with sparing of pain and temperature sensitivity.

Iatrogenic: aortic surgery, thoracic surgery, arteriography, epidural anaesthesia, spinal anaesthesia and foraminal steroid infiltration.

Spontaneous: vertebral artery occlusion (cervical spinal cord infarction), aortic diseases (thoracolumbar spinal cord infarction), aortic or vertebral artery atherosclerosis and dissection, emboligenic heart disease.