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Blockage of the Spinal Cord’s Blood Supply
(Spinal Cord Infarction; Ischemic Myelopathy)
Blockage of an artery carrying blood to the spinal cord prevents the cord from getting blood and thus oxygen. As a result, tissues can die (called infarction).
Causes include severe atherosclerosis, inflammation of blood vessels, blood clots, and sometimes procedures that involve the abdominal aorta.
Sudden back pain with pain radiating from the affected area is followed by muscle weakness and inability to feel heat, cold, or pain in the affected areas and sometimes paralysis.
Magnetic resonance imaging or myelography is usually done.
Treatment focuses on correcting the cause if possible or relieving symptoms.
Spinal cord dysfunction and paralysis are usually permanent.
Like all tissues in the body, the spinal cord requires a constant supply of oxygenated blood. Only a few arteries, which are branches of the aorta, supply blood to the front part of the spinal cord. But this blood accounts for three fourths of the blood the spinal cord receives. Thus, blockage of any one of these arteries can be disastrous. Such a blockage occasionally results from the following:
Severe atherosclerosis of the aorta (see Atherosclerosis)
Separation of the layers of the aorta's wall (aortic dissection—see Aortic Dissection)
Inflammation of blood vessels (vasculitis—see Overview of Vasculitis), such as polyarteritis nodosa
A blood clot that breaks off from the wall of the heart and travels through the bloodstream (becoming an embolus)
Procedures that involve the abdominal aorta, such as surgery to repair a bulge (aneurysm) there
The first symptoms are usually
The pain is followed by muscle weakness, and people cannot feel heat, cold, or pain in areas controlled by the part of the spinal cord below the level of the blockage. People immediately notice symptoms, which may lessen slightly over time.
If the blood supply to the front of the spinal cord is greatly reduced, the legs are numb and paralyzed. But sensations transmitted through the back of the cord—including touch, the ability to feel vibration, and the ability to sense where the limbs are without looking at them (position sense)—remain intact. The back of the cord receives blood from other sources.
Weakness and paralysis can lead to the development of pressure sores and breathing difficulties. Bladder and bowel function may be impaired, as may sexual function.
The diagnosis is usually suspected based on symptoms.
Magnetic resonance imaging (MRI), or if MRI is unavailable, myelography (see Tests for Brain, Spinal Cord, and Nerve Disorders : Myelography) is done. These tests can help doctors rule out other disorders that cause similar symptoms.
A spinal tap (lumbar puncture—see Figure: How a Spinal Tap Is Done) may be done to rule out transverse myelitis as the cause of symptoms.
Angiography can confirm that an artery to the front of the spinal cord is blocked, but it is usually unnecessary.
When possible, the cause (such as aortic dissection or polyarteritis nodosa) is treated, but otherwise, treatment focuses on relieving symptoms and managing complications because paralysis and spinal cord dysfunction are usually permanent.
Because some sensations are lost and paralysis may develop, preventing pressure sores from forming is important.
Therapy to help fluids drain from the lungs (such as deep breathing exercises, postural drainage, and suctioning) may be necessary.
Physical and occupational therapy (see Physical Therapy (PT)) can help preserve muscle function.
Because bladder function is usually impaired, a catheter is needed to drain urine. This treatment prevents the bladder from enlarging and being damaged.
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