Acute cervical cord infarction in anterior spinal artery territory with acute swelling mimicking myelitis

Al-Shaar, Hussam Abou; AbouAl-Shaar, Iyad; Al-Kawi, M. Zuheir

doi:10.17712/nsj.2015.4.20150109

Cited by 7 publications

(5 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many prior cases of SCI have demonstrated a prolonged time to nadir over many hours, including autopsy-proven cases and periprocedural SCI . The slower evolution of deficits than in cerebral infarction might be explained by diverse collateralization of spinal arterial supply with transient preservation of tissue viability before infarction, while the relatively small area of the spinal cord may also make it more susceptible to the effects of edema contributing to clinical worsening . Pain was common at presentation (72%); it may be explained by SCI activation of the spinothalamic tract or by the contributing mechanism (fibrocartilaginous embolism, artery dissection) …”

Section: Discussionmentioning

confidence: 99%

“…2,4,9 The slower evolution of deficits than in cerebral infarction might be explained by diverse collateralization of spinal arterial supply 10 with transient preservation of tissue viability before infarction, while the relatively small area of the spinal cord may also make it more susceptible to the effects of edema contributing to clinical worsening. 11,12 Pain was common at presentation (72%); it may be explained by SCI activation of the spinothalamic tract or by the contributing mechanism (fibrocartilaginous embolism, artery dissection). 9,13,14 Given the high proportion of older patients with vascular risk factors in our study, traditional stroke mechanisms (atherothrombosis) likely have an important role in SCI, 15 which may likely affect more proximal arteries than the spinal arteries themselves.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics of Spontaneous Spinal Cord Infarction and Proposed Diagnostic Criteria

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE Spinal cord infarction (SCI) is often disabling, and the diagnosis can be challenging without an inciting event (eg, aortic surgery). Patients with a spontaneous SCI are often misdiagnosed as having transverse myelitis. Diagnostic criteria for SCI are lacking, hindering clinical care and research. OBJECTIVE To describe the characteristics of spontaneous SCI and propose diagnostic criteria. DESIGN, SETTING, AND PARTICIPANTS An institution-based search tool was used to identify patients evaluated at Mayo Clinic, Rochester, Minnesota, from January 1997 to December 2017 with a spontaneous SCI. Patients provided written consent to use their records for research. Participants were 18 years and older with a diagnosis of spontaneous SCI (n = 133), and controls were selected from a database of alternative myelopathy etiologies for validation of the proposed diagnostic criteria (n = 280). MAIN OUTCOMES AND MEASURES A descriptive analysis of SCI was performed and used to propose diagnostic criteria, and the criteria were validated. RESULTS Of 133 included patients with a spontaneous SCI, the median (interquartile range) age at presentation was 60 (52-69) years, and 101 (76%) had vascular risk factors. Rapid onset of severe deficits reaching nadir within 12 hours was typical (102 [77%]); some had a stuttering decline (31 [23%]). Sensory loss occurred in 126 patients (95%), selectively affecting pain/temperature in 49 (39%). Initial magnetic resonance imaging (MRI) spine results were normal in 30 patients (24%). Characteristic MRI T2-hyperintense patterns included owl eyes (82 [65%]) and pencil-like hyperintensity (50 [40%]); gadolinium enhancement (37 of 96 [39%]) was often linear and located in the anterior gray matter. Confirmatory MRI findings included diffusion-weighted imaging/apparent diffusion coefficient restriction (19 of 29 [67%]), adjacent dissection/occlusion (16 of 82 [20%]), and vertebral body infarction (11 [9%]). Cerebrospinal fluid showed mild inflammation in 7 of 89 patients (8%). Diagnostic criteria was proposed for definite, probable, and possible SCI of periprocedural and spontaneous onset. In the validation cohort (n = 280), 9 patients (3%) met criteria for possible SCI, and none met criteria for probable SCI. CONCLUSIONS AND RELEVANCE This large series of spontaneous SCIs provides clinical, laboratory, and MRI clues to SCI diagnosis. The diagnostic criteria proposed here will aid clinicians in making the correct diagnosis and ideally improve future care for patients with SCI. The validation of these criteria supports their utility in the evaluation of acute myelopathy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characteristics of Spontaneous Spinal Cord Infarction and Proposed Diagnostic Criteria

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The diagnosis of acute noncompressive myelopathy presents a challenge to clinicians, as several possible etiologies, such as vasculature, demyelination and inflammation, need to be considered in the differential diagnoses 1–3 . In acute noncompressive myelopathy, spinal cord infarction (SCI) could mimic neuromyelitis optica spectrum disorders (NMOSD) because of several overlaps in the clinical presentations and magnetic resonance imaging (MRI) findings 4,5 . However, the treatment and prognosis may be quite different in the two diseases.…”

Section: Introductionmentioning

confidence: 99%

A comparison between spinal cord infarction and neuromyelitis optica spectrum disorders: Clinical and MRI studies

Hsu

Cheng

Liao

et al. 2019

Sci Rep

View full text Add to dashboard Cite

This study aims to investigate the clinical features and magnetic resonance imaging (MRI) findings in patients with spinal cord infarction (SCI) and neuromyelitis optica spectrum disorders (NMOSDs). Over a period of 16 years, we retrospectively analyzed 39 patients with SCI and 21 patients with NMOSD. The demographic features and clinical presentations of both diseases were carefully documented. Etiology-specific MRI features, such as the length and distribution of the lesions, the owl’s eyes sign and bright spotty lesions, were recorded and analyzed regarding their association with the clinical signs/symptoms. Patients with SCI were older than patients with NMOSD and had sudden onset of clinical symptoms with focal pain adjacent to the lesions. Concomitant spinal cord and vertebral body infarctions were frequently associated with aortic pathology (p = 0.04). In addition, artery dissection was highly associated with combined ASA and unilateral PSA infarctions and long segments of SCI (all p < 0.05). In contrast, patients with NMOSD had a relatively younger age of onset, female predominance and subacute progression of limbs weakness. As observed by MRI, the length and location of the lesions demonstrated significant differences between the two diseases (P < 0.01). The owl’s eyes sign showed more frequently in patients with SCI than NMOSD (p < 0.01). The predicted prognoses in SCI and NMOSD were significantly associated with initial motor function (muscle power), after adjustments for age and gender (p < 0.01 and p = 0.02, respectively). Along with patient demographic characteristics, lesion features on MRI can help clinicians differentiate acute noncompressive myelopathy due to SCI from that due to NMOSD, which may lead to immediate initiation of adequate therapeutic measures.

show abstract

“…These locations were different from those of vascular insult to the spinal cord (spinal cord infarction), in which lesions were more frequent in the lower thoracic and lumbar regions [ 21 ]. Several reports have shown that acute spinal cord infarction may mimic myelitis [ 30 , 31 ]. From an anatomical point of view, the middle cervical cord receives its blood supply from radicular arteries fed by the extracranial vertebral artery, while the upper thoracic cord receives its blood supply from radicular arteries fed by the aorta [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Correlations among disability, anti-AQP4 antibody status and prognosis in the spinal cord involved patients with NMOSD

et al. 2021

View full text Add to dashboard Cite

Background Neuromyelitis optica spectrum disorder (NMOSD) is a rare neuroinflammatory disorder of the central nervous system that typically involves the optic nerve, the spinal cord and other specific brain regions. In relapse of the disease, factors associated with clinical features and lesion severity are important for clinicians to predict disease-related disability. Methods We retrospectively analyzed 22 female patients with NMOSD who had spinal cord lesions. Detailed clinical features, onset symptoms, motor disability, relapse episodes, serum aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) autoantibodies and MRI characteristics were documented to correlate their associations with the nadir and three-month Expanded Disability Status Scale (EDSS) scores. Patients with three-month EDSS scores below four (< 4) were categorized as the good outcome group, while those with scores of four or more (> 4) were categorized as the poor outcome group. Results In patients with NMOSD, the mean age was 44.5 ± 12.8 years, and the mean three-month EDSS score was 4.3 ± 1.9. A significantly higher all-limb muscle power score was found in the good EDSS group than in the poor EDSS group (p = 0.01). A tendency toward longer follow-up periods and lower anti-AQP4 antibody levels was found in the good outcome group. Serum anti-AQP4 antibodies were present in 86% of patients with NMOSD, and MOG autoantibodies were found in one anti-AQP4 antibody-negative patient (33.3%). In patients with NMOSD, more than 40% of spinal cord lesions were distributed at the middle cervical and upper thoracic levels. Conclusions Our findings suggest that EDSS scores and MRC scores at the nadir had significant associations with three-month EDSS scores. The topographic distributions of the spinal cord lesions might relate to different serum anti-AQP4 antibody status. However, further studies will be needed to corroborate this finding.

show abstract

Acute cervical cord infarction in anterior spinal artery territory with acute swelling mimicking myelitis

Cited by 7 publications

References 14 publications

Characteristics of Spontaneous Spinal Cord Infarction and Proposed Diagnostic Criteria

Characteristics of Spontaneous Spinal Cord Infarction and Proposed Diagnostic Criteria

A comparison between spinal cord infarction and neuromyelitis optica spectrum disorders: Clinical and MRI studies

Correlations among disability, anti-AQP4 antibody status and prognosis in the spinal cord involved patients with NMOSD

Contact Info

Product

Resources

About