Hemodynamic infarction of the spinal cord: involvement of the gray matter plus the border-zone between the central and peripheral arteries

Abstract

Objective: Hemodynamic infarction of the spinal cord that affected an 81-year-old female having a dissecting aortic aneurysm is presented. During the graft replacement operation, systemic hypotension occurred and the patient was subsequently complicated with paraplegia of the lower limbs. The patient died 2 weeks after the surgery due to gastrointestinal bleeding. An autopsy, which did not include the brain, was performed and the spinal cord was sampled. The aim of this report is to describe the pathologic profile of the spinal cord of the patient, and to gain insight into the pathogenesis of the lesion. Methods: Histochemical and immunohistochemical methods were employed to study the spinal cord ranging from the lower thoracic to sacral segments. Results: The whole central areas of the spinal cord showed coagulation and/or liquefaction necroses, while the white matter on the circumference of the cord remained unaffected, thus exhibiting a 'ring-like' appearance. Conclusion: This case is an example of hemodynamic infarction of the spinal cord involving the gray matter that is supplied by the central artery, plus the border-zone that is supplied by both the central and peripheral arteries. The former is probably associated with selective vulnerability of the gray matter to ischemia, while the latter is probably associated with intrinsic vulnerability of the border-zone to systemic hypotension or low blood-flow states.

Periconal arterial anastomotic circle and posterior lumbosacral watershed zone of the spinal cord

“…In addition, the higher metabolic needs of the gray matter also participate in its increased sensitivity to ischemia. Watershed injury of the gray matter ranges from focal anterior or posterior horns lesions, resulting in a typical ‘owl-eye’ or ‘snake-eye’ appearance,6 to complete infarction of the gray substance, with or without white matter involvement 4 5 27…”

A 66-Year-Old Woman with a Progressive, Longitudinally Extensive, Tract Specific, Myelopathy

“…Antineuronal nuclear antigen 1 (ANNA-1, also known as anti-Hu), antineuronal nuclear antigen 2 (ANNA-2), antineuronal antigen 3 (ANNA-3), antiamphiphysin, and anticollapsing response mediator protein 5 (CRMP-5) are among the most common antibodies identified in patients with paraneoplastic myelopathies [17]. However, antibodies directed against a number of other surface and intracellular antigens have also been reported [8, 18]. Paraneoplastic myelopathies have been reported in association with many forms of cancer, the most common being breast and lung cancer [17].…”

“…The histopathologic sequelae of ischemia are variable and depend on both the level and extent of vascular compromise. Autopsy findings in patients affected by spinal cord infarction often include preferential involvement of gray matter; however, in a large series, the most severe cases also showed white matter necrosis [18, 20]. Other reports describe involvement of both gray and white matter [21].…”

Delayed post-traumatic spinal cord infarction in an adult after minor head and neck trauma: a case report

“…With respect to pial versus sulcal artery involvement, Ishizawa et al . [16], in a histopathological study of hemodynamic spinal cord infarction, showed that the infarction involved the gray matter supplied by the central artery while the periphery of the spinal cord supplied by the pial arteries remained intact. In our patient, the pathological finding was altered by the pre-existing cervical spondylotic myelopathy, and delineation between pial versus sulcal vascular territories was not possible.…”