Neurology-Online

Stroke in the spinal cord

Definition - What is Spinal Cord Stroke?

The spinal cord is supplied with blood by several arteries. There are horizontal and vertical arteries, all of which are connected to provide the safest and most adequate blood supply possible.

A stroke in the spinal cord means that a circulatory disorder has arisen in this vascular system and, as a result, an undersupply of the spinal cord with the loss of nerve cells.

This varies depending on the height in the spinal cord. In general, however, there are sensory disorders, pain and paralysis. If you experience such symptoms, it is very important to see your doctor immediately.

Causes of a stroke in the spinal cord

A circulatory disorder of the spinal cord can have different causes.

Diseases of the main artery

Diseases of the main artery (aorta) can affect the blood flow to the spinal cord as this large vessel supplies blood to the smaller arteries. With a widening or bulging of the aorta, as well as with a constriction, it can lead to circulatory problems. Inflammation or operations on the aorta can also lead to insufficient supply.

Anterior spinal artery syndrome

Another cause is the so-called anterior spinal artery syndrome, in which the anterior artery (Anterior spinal artery) insufficient blood supply to the spinal cord, causing a stroke. The cause of the circulatory disorder can be calcium deposits in the vessel (arteriosclerosis), the disease of small vessels due to metabolic diseases such as diabetes mellitus, a tear in the wall of the main artery (Aortic dissection), an autoimmune disease, or a tumor.
A frequent cause, however, is the undersupply of this artery as a result of an operation for a main artery sac (Aortic aneurysm).

Other causes

Other causes are discomfort in the venous system of the spinal cord or thrombosis. A herniated disc and tumors can also lead to a stroke in the spinal cord.

How is it diagnosed?

If a spinal stroke is suspected, a swift neurological examination should be carried out, followed by magnetic resonance imaging with and without contrast agent. This can be used to depict circulatory disorders, but also masses or changes in the spinal cord.
There should also be a vessel representation (Angiography) of the spinal cord. A sonography or computed tomography of the abdomen to rule out a disease of the main artery would follow.

To rule out other inflammatory or autoimmune diseases, a blood sample and a nerve water test can be carried out.

Find out more about diagnostic procedures in the next article: MRI of the spine

These are the symptoms I can tell if I have a stroke in the spinal cord

If there is a circulatory disorder in the anterior region of the spinal cord (Anterior spinal artery syndrome) the symptoms appear suddenly and begin with tingling, "pins and needles" and numbness at the height of the stroke.
Within the first hour, further symptoms suddenly set in, such as flaccid paralysis and a disturbed pain and temperature sensation. There is also bladder and rectal paralysis with urinary and stool retention.

If the circulatory disorder affects the back of the spinal cord (Posterior Spinal Artery Syndrome) other symptoms develop. Here, the deep sensitivity, i.e. the perception of the position and posture of the body, is impaired, which leads to gait disorders (Ataxia) leads. In addition, symptoms of paralysis also occur here.
In a major stroke, all of these symptoms can appear at the same time, causing paraplegia. If you experience any of these symptoms, it is very important to see a doctor immediately.

Are you more interested in this topic? Read more about this under:

Signs of a stroke
Stroke Symptom Test - I can test this myself

Treatment options for a stroke

Treatment is always based on the cause. A stroke of the spinal cord is an absolute emergency and must be diagnosed and treated immediately, since nerve tissue perishes due to the circulatory disorder.

Immediate surgical treatment is necessary for diseases of the aorta, for example a tear in the wall due to a bulging. In the case of inflammation caused by an autoimmune disease, both the aorta and smaller vessels can be affected. The autoimmune disease is treated with cortisone and aspirin is given to thin the blood.
In the case of anterior spinal artery syndrome, so-called thrombocyte aggregation inhibition, i.e. blood thinning, using 100 mg ASA (aspirin) performed daily.

In the case of urinary retention, it is very important to insert a urinary catheter so that the urinary bladder does not have to suffer any consequences.

If a tumor or a herniated disc are the cause of the circulatory disorder, then surgical treatment should also be considered here. Overall, a thrombosis prevention should be carried out with a blood thinner for a cross section.

You can read detailed information on this topic in the next article: Therapy of a stroke

When will I be symptom-free again?

With a stroke of the spinal cord, just as with any other stroke, the time until the start of therapy is crucial. The faster the cause is resolved, the faster the tissue can recover and the symptoms go away.
The exact duration of the symptoms is difficult to predict in general, as it varies from person to person and depends on the extent of the stroke.

A stroke often leads to permanent consequential damage. Find out more at: These are the consequences of a stroke!

Prognosis

The prognosis also depends heavily on how large the lesion is and how quickly the therapy was initiated. In one study, up to 70% of those affected were able to partially or fully recover. The anterior spinal artery syndrome has an unfavorable prognosis.
In general, rehabilitation measures are extremely important and can help to maintain or regain some skills. Furthermore, the prevention of complications such as thrombosis and inflammation is of great importance for the prognosis of the patient.

Our next article could also be of interest to you: Life expectancy after a stroke