Spinal cord infarction secondary to intervertebral disc embolism

Srigley, John R.; Lambert, Colin D.; Bilbao, Juan M.; Pritzker, Kenneth P.H.

doi:10.1002/ana.410090315

Cited by 55 publications

(19 citation statements)

References 14 publications

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“…Naiman et al 7 suggested two possible mechanisms: 1) a traumatic rupture of the annulus fibrosus, followed by tearing of the adjacent radicular artery with extrusion of nucleus pulposus material; 2) "injection" of disc material into arteries of the disc space, with further retrograde migration into a radicular artery. Subsequent reports 8 "" have stressed the importance of extrusion of disc material into the vertebral body (Schmorl's nodes), with access to sinusoids and veins of the bone marrow as the primary phenomenon, 13 leading ultimately to both venous and arterial embolization, as a result of arteriovenous communications normally present at the level of the spinal cord. 39 Trauma has occasionally preceded the onset of the myelopathy, 7 but most cases have affected individuals of sedentary habits, as was the case with our patient.…”

Section: Decussation Of the Pyramidsmentioning

confidence: 99%

“…4 -5 - 24 -3I This form of nystagmus is considered to be a manifestation of lesions involving either the anterior cerebellar vermis .or the medulla. 12 The medullary lesions associated with vertical upbeat nystagmus have been of tumoral 13 -- 14 or vascular?-5 -24 -3I character, and the constant unilateral or bilateral involvement of the medial longitudinal fasciculus (MLF) has been implicated in its causation. 21 The specificity of the medially-located medullary lesions for the production of pure vertical upbeat nystagmus is further supported by its absence in lateral medullary infarctions, 35 which spare the MLF.…”

Section: Decussation Of the Pyramidsmentioning

confidence: 99%

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Medial medullary infarction from fibrocartilaginous embolism to the anterior spinal artery.

Kase¹,

Varakis²,

Stafford³

et al. 1983

Stroke

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SUMMARY A previously healthy young woman presented with sudden onset of quadriplegia, anesthesia below the C3 dermatome, respiratory paralysis, vertical nystagmus, ocular bobbing and cortical blindness. After partial resolution of the latter deficits, she remained quadriplegic, with a C3 level of anesthesia, and in respiratory paralysis until death from complications of a fulminant pulmonary infection. Autopsy disclosed bilateral infarctions of the medial aspect of the medulla and the upper cervical cord, in the distribution of the anterior spinal artery. Multiple sites of arterial occlusion by fibrocartilaginous material were found in branches of the anterior spinal artery, in correspondence with the sites of infarction. A review of the literature disclosed only 2 examples of medial medullary syndrome from embolism to the anterior spinal artery.Stroke, Vol 14, No. 3, 1983 INFARCTION IN THE MEDULLA OBLONGATA is usually unilateral and limited to its dorso-lateral aspect. Medial medullary infarction occurs rarely, and it results from occlusion of the vertebral or anterior spinal artery (ASA).1 -2 Bilateral symmetric involvement of this area by vascular lesions has been described on three instances before, [3][4][5] in one of them as a result of embolic occlusion of ASA branches. 4 This report describes the case of a young patient with bilateral embolic medial medullary infarctions. The topography of the medullary lesions and the associated vascular pathology were studied by serial sections, which disclosed multiple occlusions of the ASA branches by fibrocartilaginous emboli.Case Report A 23 y/o female bank clerk complained of sudden occipital headache while at work, and vomited once. Taken immediately to the hospital, on her way she developed bilateral arm weakness, rapidly followed by weakness of the legs. By the time of her arrival in the emergency room a few minutes after onset, she had become unresponsive, had shallow respirations at a rate of 3 per minute and then suffered a respiratory arrest. Because of marked trismus, intravenous diazepam (Valium) was required to perform oral endotracheal intubation. After 10 minutes of mecnanical ventilation she was able to open her eyes spontaneously. Physical examination showed regular pulse at 72 per minute, temperature 37 degrees C. She was able to open and close the eyes spontaneously and on verbal command, and the extraocular movements were conjugate and full in all directions. Testing of visual func-

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Section: Decussation Of the Pyramidsmentioning

confidence: 99%

Section: Decussation Of the Pyramidsmentioning

confidence: 99%

Medial medullary infarction from fibrocartilaginous embolism to the anterior spinal artery.

Kase¹,

Varakis²,

Stafford³

et al. 1983

Stroke

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“…2 Alternatively, an embolus from an intervertebral disc can occlude the anterior spinal artery. 3 The incidence is not precisely known but is considerably lower than that of infarction in the brain. 4 That the volume of the brain is so much larger may be only a part of the explanation; according to some studies, spinal arteries themselves are rarely affected by atherosclerosis5; in addition, the spinal cord has a rich anastomotic network of arteries.…”

mentioning

confidence: 99%

Spinal infarction. A follow-up study.

Pelser

Gijn

1993

Stroke

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Ten patients with spinal cord infarction were followed up after 1 to 27 (median, 3) years to establish the sequelae of the disease in the long term. Eight surviving patients were interviewed about mobility, pain, and activities of daily living. All 8 patients had residual weakness in the legs; 7 of them were able to live at home without professional help. All but 1 suffered from continuous pain, which was not dependent on the degree of weakness. Motor function had improved to some extent in all patients, but pain is a disabling feature in the long term.

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“…To our knowledge, no case of both vertebral and rib infarction associated with spinal cord infarct has been reported, and only 8 cases of vertebral body infarction associated with spinal cord infarct have been published [2][3][4][5]. Two anatomical features may explain the rarity of this association.…”

Section: Case Reportmentioning

confidence: 85%

Vertebra, Rib and Spinal Cord Infarction Caused by Probable Fibrocartilaginous Embolism

Masson

Boukriche

Berthelot³

et al. 2001

Cerebrovasc Dis

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Spinal cord infarction secondary to intervertebral disc embolism

Abstract: A 45‐year‐old man acutely developed high spinal cord infarction. At autopsy a clinically occult fracture of a vertebral body was demonstrated. Emboli consisting of intervertebral disc material were found in marrow vessels and in the anterior spinal artery in the area of the infarct.

Cited by 55 publications

References 14 publications

Medial medullary infarction from fibrocartilaginous embolism to the anterior spinal artery.

Medial medullary infarction from fibrocartilaginous embolism to the anterior spinal artery.

Spinal infarction. A follow-up study.

Vertebra, Rib and Spinal Cord Infarction Caused by Probable Fibrocartilaginous Embolism

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