Spontaneous spinal cord infarction in Austria: a two-center comparative study

Abstract

Background: Spinal cord infarction (SCI) is a neurological emergency associated with high rates of persistent neurological deficits. Knowledge about this rare but potentially treatable condition needs to be expanded. Objective: To describe the characteristics of spontaneous SCI in a large retrospective series of patients treated at two tertiary care centers in Austria. Methods: We performed a descriptive and comparative analysis of spontaneous SCI treated at the University Hospitals of Salzburg and Graz between the years 2000 and 2020. The analysis included pre- and in-hospital procedures, clinical presentation, etiology, diagnostic certainty, reperfusion therapy, and functional outcome at discharge. Results: We identified 88 cases, 61% were ascertained in the second half of the study period. The median age was 65.5 years [interquartile range (IQR) = 56–74], 51.1% were women. Anterior spinal artery infarction was the predominant syndrome (82.9%). Demographics, vascular comorbidities, and clinical presentation did not differ between the centers. The most frequent etiology and level of diagnostic certainty were distinct, with atherosclerosis (50%) and definite SCI (42%), and unknown (52.5%) and probable SCI (60%) as front runners in Salzburg and Graz, respectively. Patients arrived after a median of 258.5 min (IQR = 110–528) at the emergency room. The first magnetic resonance imaging (MRI) of the spinal cord was performed after a median of 148 min (IQR = 90–312) from admission and was diagnostic for SCI in 45%. Two patients received intravenous thrombolysis (2.2%). The outcome was poor in 37/77 (48%). Conclusion: Demographics, clinical syndromes, and quality benchmarks for spontaneous SCI were consistent at two Austrian tertiary care centers. Our findings provide the foundation for establishing standards for pre- and in-hospital care to improve outcomes.

Long-term Outcomes After Periprocedural and Spontaneous Spinal Cord Infarctions

“…32 Spinal cord lesions may not be discernible on T2-weighted imaging within the first 12-24 hours after onset of symptoms. 16,33 In this study, the exact time interval from symptom onset to MRI examination could not be defined. However, the first available MRI showed imaging findings supporting or confirming the SCInf diagnosis in most of the patients (91%).…”

Spinal Cord Infarction Thrombolysed at Seven Hours: A Case Report and Review of Literature

“…Seven (44%) of the 16 patients had a good recovery (mRS 0-2). The outcome in the delayed time window (beyond 270 minutes) was good in two out of three patients (mRS 1 at 11 months, mRS 2 at three months, and mRS 3 at three months in our patient [6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

A Rare Case of Cardioembolic Spinal Stroke in a Young Female: Case Report

“…The patient was treated with anticoagulation and regained independence with physical rehabilitation. Evidence for thrombolysis and anticoagulation in SCI is limited [5,[15][16][17][18]. Although few studies report thrombolysis for spinal stroke patients without harm, there is no evidence for efficacy.…”