Isolated Infarctions of the Conus Medullaris: Clinical Features and Outcomes

Tan, You-Jiang; Manohararaj, N.

doi:10.1016/j.jstrokecerebrovasdis.2021.106055

Cited by 6 publications

(5 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The aetiology of central nervous system involvement in patients with IVLBCL is thought to be a vascular disorder, and arterial infarction is frequent in the brain type, as observed in the present study [3]. The conus medullaris, however, has anastomoses and is resistant to ischaemia in the spinal cord; therefore, spinal cord infarctions are very rare [27,28]. As such, the high incidence of conus medullaris lesions suggests the involvement of a mechanism that is different from arterial infarction.…”

Section: Although Conus Medullaris Lesions Are Observed In Spinal Duralsupporting

confidence: 55%

“…Venous congestive myelopathy differs from arterial infarction and has a slow course [30], which is consistent with what was observed in the present study. Additionally, because the conus medullaris is rich in arteries due to the anastomoses [27], it is possible that the conus medullaris is more susceptible to the dysfunction of venous drainage. Therefore, venous congestion is a possible cause of the conus medullaris lesions suggestive of IVLBCL.…”

Section: Discussionmentioning

confidence: 99%

Section: Although Conus Medullaris Lesions Are Observed In Spinal Duralmentioning

confidence: 99%

See 2 more Smart Citations

Progressive conus medullaris lesions are suggestive of intravascular large B‐cell lymphoma

Kitahara

Kanazawa

Natsumeda

et al. 2023

Euro J of Neurology

View full text Add to dashboard Cite

Background and purposeSpinal cord lesions are observed in 40% of all central nervous system lesions in intravascular large B‐cell lymphoma (IVLBCL). However, because IVLBCL is a very rare disease, its clinical features are not well defined, which may delay appropriate diagnosis and treatment, whilst the acute to subacute course of brain lesions in patients with IVLBCL is well established. Therefore, this study aimed to clarify the clinical features of spinal cord lesions in patients with IVLBCL.MethodsThe medical records of patients with IVLBCL admitted to our hospital between 2010 and 2020 were searched. The inclusion criteria were preceding neurological symptoms without non‐neurological symptoms and pathologically confirmed IVLBCL in various organs. Clinical features of spinal cord involvement in patients with IVLBCL were assessed and distinguished from those of brain involvement.ResultsSixteen consecutive patients with IVLBCL were divided into two groups: six patients with spinal involvement (spinal cord type) and 10 patients with brain involvement (brain type). In the spinal cord type, four patients had chronic progression and two had subacute progression. Acute progression (0% vs. 80.0%) and sudden onset (0% vs. 50.0%) occurred significantly less frequently in the spinal cord than in the brain. All spinal cord lesions involved the conus medullaris.ConclusionsSpinal cord involvement in IVLBCL has a predominantly chronic progressive course that is exclusive to brain involvement. Conus medullaris lesions are suggestive of IVLBCL and are useful for early and accurate diagnosis and treatment.

show abstract

Section: Although Conus Medullaris Lesions Are Observed In Spinal Duralsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Progressive conus medullaris lesions are suggestive of intravascular large B‐cell lymphoma

Kitahara

Kanazawa

Natsumeda

et al. 2023

Euro J of Neurology

View full text Add to dashboard Cite

show abstract

“…The main pathological changes which can result in this appearance are cystic necrosis of the central gray matter of the ventrolateral column of the spinal cord and loss of neurons in the anterior horn of the spinal cord[ 29 ]. It is usually related to lower motor neuron syndrome, such as Hirayama disease[ 30 , 31 ], spinal muscular atrophy syndrome[ 32 ], cervical spondylotic myelopathy[ 33 ], amyotrophic lateral sclerosis[ 34 ], and anterior spinal artery ischemia[ 35 - 37 ], Detailed identification is shown in Table 2 [ 34 , 38 - 41 ]. There is a watershed area between the sulcus commissural artery and the coronary artery ring sent by the anterior spinal artery.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous conus infarction with "snake-eye appearance" on magnetic resonance imaging: A case report and literature review

Zhang¹,

Xu²,

Wang³

et al. 2023

World J Clin Cases

View full text Add to dashboard Cite

BACKGROUND Infarction of the conus medullaris is a rare form of spinal cord infarction. The first symptom is usually acute non-characteristic lumbar pain, followed by lower limb pain, saddle numbness, fecal incontinence, and sexual dysfunction. Spontaneous conus infarction with "snake-eye appearance" on magnetic resonance imaging has rarely been reported. CASE SUMMARY We report a 79-year-old male patient with spontaneous conus infarction who had acute lower extremity pain and dysuria as the first symptoms. He did not have any recent history of aortic surgery and trauma. Magnetic resonance imaging revealed a rare "snake-eye appearance." In addition, we reviewed the literature on 23 similar cases and summarized the clinical features and magnetic resonance manifestations of common diseases related to the "snake-eye sign" to explore the etiology, imaging findings, and prognosis of spontaneous conus infarction. CONCLUSION We conclude that acute onset of conus medullaris syndrome combined with "snake-eye appearance" should be strongly suspected as conus medullaris infarction caused by anterior spinal artery ischemia. This special imaging manifestation is helpful in the early diagnosis and treatment of conus infarction.

show abstract

“…This can result in a 'dominant PSA' supplying both sides of the dorsal cord, rendering them vulnerable to concurrent ischemia when arterial ow through this PSA is disrupted. Moving inferiorly, the PSAs communicate extensively with neighbouring segmental medullary and ascending cervical arteries at the cervical cord, the posterior intercostal and the great radiculo-medullary arterires at the thoracic cord, before anastomosing with the ASA at the conus medullaris to form a 'arterial basket' [41]. Additionally, they become increasingly non-contiguous towards and at the thoracic cord, forming longitudinal channels amidst an extensive pial arterial meshwork [42].…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcomes of Posterior Spinal Artery Infarction: A Systematic Review

Tan,

Teo,

Yeo

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Objective We aim to describe the clinical features and outcomes of patients with posterior spinal artery infarctions, and to identify factors associated with poor ambulatory outcomes. Methods We performed a systematic review and retrospective analysis on the characteristics and outcomes of patients with posterior spinal artery infarctions reported over the past 30 years. Results We analyzed 40 cases from 33 studies between January 1993 till June 2023. Their median age was 55 years (range 19–84), with 23 males and 17 females. Cardiovascular risk factors were present in half (21/40, 53%). Pain (10/40, 48%) and motor deficits (27/39, 69%) were common Infarcts preferentially affected the cervical cord (29/40, 73%), and were frequently attributed to vertebral artery dissections (8/40, 20%) endovascular treatment complications (7/40, 18%)., However, the underlying cause remained unknown in a quarter (10/40, 25%). Treatment involved isolated or concomitant use of anticoagulants (8/28, 29%), antiplatelet (18/28, 64%), and steroids (5/28, 18%). Prognosis appeared fair as most could ambulate (28/34, 82%), but over a quarter could only do so with assistance (8/28, 29%). Patients who were older, (median age [range]: 67 [52–84] vs 56 [28–79], p = 0.055), with preceding trauma (50% vs 11%, p = 0.053), or with infarcts involving three or more cord segments (83 vs 33%, p = 0.062) may be likelier to experience non-ambulatory outcomes. Conclusion Though rare, posterior spinal artery infarctions’ propensity for disability renders their early recognition especially vital. Pain and preceding trauma or endovascular treatment are diagnostic clues. Old age, preceding trauma, and longer infarcts may be associated with non-ambulatory outcomes.

show abstract

Isolated Infarctions of the Conus Medullaris: Clinical Features and Outcomes

Cited by 6 publications

References 27 publications

Progressive conus medullaris lesions are suggestive of intravascular large B‐cell lymphoma

Progressive conus medullaris lesions are suggestive of intravascular large B‐cell lymphoma

Spontaneous conus infarction with "snake-eye appearance" on magnetic resonance imaging: A case report and literature review

Clinical Features and Outcomes of Posterior Spinal Artery Infarction: A Systematic Review

Contact Info

Product

Resources

About