Non-traumatic ischaemic myelopathy: a review of 25 cases

Abstract

SummaryThe causes of ischaemic myelopathy are described in 25 patients. Nine developed following surgical manipulation or traumatic laceration of the aorta, 1 following intercostal artery ligation, 3 following aortic aneurysm dissection, 2 following myo cardial infarction and/or cardiac arrest, 7 in the absence of any specifically iden tifiable predisposing factors, and 3 in association with decompression sickness. The degree of clinical recovery was greater among those with incomplete spastic (as opposed to complete flaccid) paralysis and among those in whom sensory loss below the level of injury was incomplete. Despite the diversity of mechanisms that may lead to the development of spinal cord ischaemia, structural damage seems in most instances to affect either grey matter or white matter predominantly. Some of the possible reasons for these preferential sites of damage are discussed. Key words: Ischaemic myelopathy; Paraplegia; Aortic diseases; Spinal vascular disease.There are only a few analytical studies in the English language literature of large series of patients with ischaemic myelopathy, although a number of isolated examples of spinal cord vascular lesions have been published. The most recent reviews of this type include those of Garland, et al. (1966), Mannen (1966, Henson andParsons (1967), andSilver andBuxton (1974). The subject has not been treated in any great detail in standard textbooks of neurology (Adams and Victor, 1985) or neuropathology (Adams, et al., 1984;Davis and Robertson, 1985), probably because of the relatively low frequency with which the condition is encountered. Blackwood (1958), for example, was unable to find a single example of arterial softening of the spinal cord among 3737 postmortem examinations conducted over a 50 year period at the National Hospital, Queen Square.On the arterial side, the better recognised causes of ischaemic myelopathy include recent aortic surgery or traumatic injury, aortic aneurysm dissection,

Selective Vulnerability of the Lumbosacral Spinal Cord After Cardiac Arrest and Hypotension

“…6,7,[15][16][17][23][24][25]34,36 Our results confirm select neuropathological studies reporting the predominance of ischemic changes in the lumbosacral cord after a global ischemic episode. 15,17,24,25,34 Neuronal necrosis restricted to the lumbosacral level of the spinal cord was initially reported by Gilles and Nag 24 in 6 neonates suffering transient cardiopulmonary arrest. These findings were later confirmed in a larger series of premature infants with clinically documented hypotensive episodes 34 and 2 adult patients after cardiac arrest.…”

“…6,9,11,12 This pattern of vascularization of the spinal cord has been equated with increased sensitivity of this area to ischemic injury. There have been, however, individual case reports [13][14][15][16][17][18][19][20][21][22] and clinical 23 and clinicopathological studies 20,24,25 suggesting that global ischemia may affect the low thoracic and lumbosacral cord to a greater extent than the other levels of the spinal cord. We performed a retrospective review of neuropathological changes in the brains and spinal cords of survivors of cardiac arrests or severe hypotensive episodes to reevaluate the frequency and distribution of neuronal injury in the spinal cord associated with ischemic encephalopathy in adults.…”

Ischaemic myelopathy following aortic surgery or traumatic laceration of the aorta

“…There are two thin posterior spinal arteries with a lower number of feeders. Kim et al 9 suggested that in case of impairment of perfusion (hypovolemia or cross-clamping and according to the site of cross-clamping), preferential damage involved the grey matter and was associated with a¯accid, lower motoneurone type of weakness. They also suggested that localised damage, such as is seen following a lesion of a major radicular artery, may lead to localised spinal cord infarction in its territory of supply.…”

“…Of these two had a preoperative paraplegia and one was neurologically unimpaired. Six had dissecting aortic aneurysms (3,7,8,9,11,12). All but one were neurologically unimpaired before the surgery.…”

Paraplegia aguda. Uma complicação rara da dissecção aórtica

“…Uma revisão da literatura permitiu-nos encontrar algumas referências sobre paraplegia, conseqüente à DAA, a maioria sob forma de relato de caso, sendo que nenhum autor reuniu mais do que três pacientes em suas casuísticas [11][12][13][14][15][16][17][18] . A paraplegia é atribuída a isquemia ou infarto da medula espinhal devido a interrupção do fluxo sangüíneo para as artérias espinhais anteriores e posteriores.…”