Vascular Disease of the Spinal Cord
Blood Supply
Origin: vertebral, subclavian, iliac arteries, aorta. Branches form single anterior median spinal artery, two posterior spinal arteries.
Thoracic region: blood supply relatively sparse. Infarction most likely to occur at T4-T9.
Anterior 2/3, central area of cord supplied by anterior spinal artery; posterior 1/3 from posterior spinal arteries, pial arteriolar plexus.
Spinal Cord Infarction
Anterior spinal artery infarction much more common than posterior because collateral supplies differ; 1% to 2% of stroke admissions.
Common etiologies: atheromatous thromboembolism from aorta; complication of thoracoabdominal aneurysm repair.
Symptoms and signs: onset usually sudden. Transient lancinating or burning, local or radicular back pain; deep aching pain in both legs; burning pain ascends from feet to abdomen. Followed by symmetric leg and (depending on spinal level) arm weakness, urinary and fecal incontinence, sensory level. Proprioception and vibration sensation always spared. Tone flaccid at first, then spastic within weeks. Tendon reflexes decreased at level of lesion, increased below. Bilateral Babinski signs.Related posts:
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