Retrospective case series of outcomes following spinal cord infarction

New, Peter W; McFarlane, Caroline

doi:10.1111/j.1468-1331.2012.03702.x

Cited by 27 publications

(31 citation statements)

References 20 publications

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“…8,18,19 Patients with an infectious aetiology also appear to have some notable differences compared with those with spinal cord infarction. 18 Regarding the pattern of complications, those with an infectious aetiology have a higher prevalence of spasticity and a lower prevalence of pneumonia. Furthermore, they have a much better improvement in their AIS grade, which explains their significant improvement in bladder, bowel and mobility functioning, as shown in Table 5.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation outcomes following infections causing spinal cord myelopathy

New

Astrakhantseva

2014

Spinal Cord

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Study design:Retrospective, open-cohort, consecutive case series. Objective: To describe the demographic characteristics, clinical features and outcomes in patients undergoing initial in-patient rehabilitation after an infectious cause of spinal cord myelopathy. Setting: Spinal Rehabilitation Unit, Melbourne, Victoria, Australia. Admissions between 1 January 1995 and 31 December 2010. Methods: The following data were recorded: aetiology of spinal cord infection, risk factors, rehabilitation length of stay (LOS), level of injury (paraplegia vs tetraplegia), complications related to spinal cord damage and discharge destination. The American Spinal Injury Association (ASIA) Impairment Scale (AIS) and functional independence measure (FIM) were assessed at admission and at discharge. Results: Fifty-one patients were admitted (men ¼ 32, 62.7%) with a median age of 65 years (interquartile range (IQR) 52-72, range 22-89). On admission, 37 (73%) had paraplegic level of injury and most patients (n ¼ 46, 90%) had an incomplete grade of spinal damage. Infections were most commonly bacterial (n ¼ 47, 92%); the other causes were viral (n ¼ 3, 6%) and tuberculosis (n ¼ 1, 2%). The median LOS was 106 days . The most common complications were pain (n ¼ 47, 92%), urinary tract infection (n ¼ 27, 53%), spasticity (n ¼ 25, 49%) and pressure ulcer during acute hospital admission (n ¼ 19, 37%). By the time of discharge from rehabilitation, patients typically showed a significant change in their AIS grade of spinal damage (Po0.001). They also showed significant improvement (Po0.001) in their FIM motor score (at admission: median ¼ 27, IQR 20-34; at discharge: median ¼ 66, IQR 41-75). Conclusion: Most patients returned home with a good level of functioning with respect to mobility, bladder and bowel status, and their disability improved significantly.

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Section: Discussionmentioning

confidence: 99%

Rehabilitation outcomes following infections causing spinal cord myelopathy

New

Astrakhantseva

2014

Spinal Cord

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“…3 Overall, some degree of initial recovery is observed in the majority of patients regardless of etiology, although the maximal recovery period appears to be soon after infarct. 16 Furthermore, there are no data regarding recurrence risk, making it difficult to counsel patients. Given the potential for permanent neurologic disability, however, it is not unreasonable to advise patients to limit activities that load the spinal column.…”

Section: Figurementioning

confidence: 99%

Posterior Spinal Cord Infarction Due to Fibrocartilaginous Embolization in a 16-Year-Old Athlete

et al. 2014

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Spinal cord infarction is extremely rare in children, and, similar to cerebrovascular infarcts, the pathogenesis is different from adults. Spinal cord infarcts are most commonly reported in adults in the context of aortic surgery; in children, the etiology is frequently unknown. Fibrocartilaginous embolization is a potential cause of spinal cord infarct in both populations. It is a process that occurs when spinal injury has resulted in disc disease, and subsequently disc fragments embolize to the cord, resulting in ischemia and/or infarction. In this report, we present a 16-year-old athlete who presented with symptoms of acute myelopathy after a period of intense exercise. Our original concern was for an inflammatory process of the spinal cord; however, given her history of competitive tumbling and degenerative disc changes on her initial spine magnetic resonance imaging scan, diffusion-weighted imaging was performed, which demonstrated acute spinal cord infarction. Unlike many cases of spinal cord infarction, our patient was fortunate to make a near-complete recovery. This case highlights the importance of recognizing rare causes of spinal cord pathology and considering infarction in the differential diagnosis of acute myelopathy because management and prognosis varies. Pediatrics 2014;134:e289-e292 AUTHORS:

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“…Some functional improvement is commonly observed over time, which might not be verified on the American Spinal Injury Association (ASIA) impairment scale. Independent gait can be achieved in cases of incomplete SCI, whereas up to 60% of patients remain wheelchair bound [6,9,18,21]. Another study reported more favorable short-term outcomes, which was present in two-thirds of patients, whereas 25% of patients did not show any clinical improvement on leaving the hospital [10].…”

Section: Clinical Presentation Etiology and Prognosismentioning

confidence: 94%

“…SCI in the setting of cardiac arrest and acute aortic rupture or dissection, and those with high cervical lesions are at greatest risk for fatality [5]. Patients with SCI have a persistently elevated mortality rate after hospital discharge [5,6,11,18,20,21]. In the largest study of 115 patients with SCI, 5-and 10-year survival rates were 55% and 42%, respectively [5].…”

Section: Clinical Presentation Etiology and Prognosismentioning

confidence: 98%