Repeated early thrombolysis in cervical spinal cord ischemia

Etgen, Thorleif; Höcherl, Constanze

doi:10.1007/s11239-015-1332-1

Cited by 19 publications

(12 citation statements)

References 11 publications

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“…When combining all patients (n = 11), AIM was initially misdiagnosed as cerebral stroke in 4/11 of all patients, and only 6/11 had an acute spinal imaging before thrombolysis (3 MRIs and 3 CTs). The cause of stroke was atherosclerotic in all patients except one periprocedural AIM related to embolization of a C2-vertebral metastasis, 7 one with undetermined cause, 9 and one from degenerative cervical canal stenosis. 11…”

Section: Resultsmentioning

confidence: 95%

“…Of the 51 articles identified on MEDLINE using our search strategy, 46 did not present thrombolysis of AIM and 5 did. 5–9 No further cases were identified through the reference list, but two other cases 10,11 were indicated to us by the reviewers of this manuscript. Among these seven thrombolyzed AIM patients (one woman, aged 55–81 years), one had two thrombolyses 9 (see Table 1).…”

Section: Resultsmentioning

confidence: 99%

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Acute ischemic myelopathy treated with intravenous thrombolysis: Four new cases and literature review

Jankovic

Bataillard²,

Mercier

et al. 2019

International Journal of Stroke

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Background Intravenous thrombolysis is a well-established treatment of ischemic stroke within 4.5 h. However, its effectiveness in acute ischemic myelopathy is unknown. Purpose We describe a series of four acute ischemic myelopathy patients treated with intravenous thrombolysis within 4.5 h and review the current literature to explore this treatment feasibility, potential safety, and efficacy. Methods We reviewed all routinely collected clinical, radiological, and follow-up data of patients with a final acute ischemic myelopathy diagnosis who received acute intravenous thrombolysis in our stroke network. We also reviewed thrombolyzed acute ischemic myelopathy patients in the literature. Results Four patients (three women) aged 57 to 83 years presented with acute uni- or bilateral extremity paresis, considered initially as cerebral strokes in two of them. After excluding contraindications by brain imaging in three, spinal computed tomography in one and confirmation of acute ischemic myelopathy on spinal magnetic resonance imaging in one patient, intravenous thrombolysis was administered at 135, 190, 240, and 245 min accordingly. Subacute diffusion-weighted imaging-magnetic resonance imaging confirmed acute ischemic myelopathy in all but one patient. Favorable outcome was achieved in two patients rapidly and in three patients at three-month follow-up. We identified seven other thrombolyzed acute ischemic myelopathy patients in the literature, who showed variable recovery and no hemorrhagic complications. Conclusions With appropriate acute imaging, intravenous thrombolysis after acute ischemic myelopathy is feasible and potentially safe within 4.5 h. Given the potential of benefit of thrombolysis in acute ischemic myelopathy, this treatment warrants further efficacy and safety studies.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Acute ischemic myelopathy treated with intravenous thrombolysis: Four new cases and literature review

Jankovic

Bataillard²,

Mercier

et al. 2019

International Journal of Stroke

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“…Yet, whether a time window of 4.5 h or even beyond this period can be translated to spinal cord infarction remains unclear (34, 35). The few case reports available seem to confirm the safety profile within the 4.5 h time frame (11–14). Another issue is the fact that a T2/DWI mismatch concept is not established for spinal cord infarction and dynamics of lesion evolution are only scarcely known.…”

Section: Discussionmentioning

confidence: 91%

“…Indeed, tissue plasminogen activator (t-PA) is an effective therapy for ischemic stroke involving both anterior and posterior circulations within the 4.5 h timeframe (10). More recently, a few case reports delivered insights to feasibility and both potential safety and efficacy of t-PA administration in acute spinal cord infarction (11–15). A timely diagnosis is a pre-requisite to allow administration of t-PA more frequently in patients with spinal cord infarction.…”

Section: Introductionmentioning

confidence: 99%

Delayed Hospital Presentation and Neuroimaging in Non-surgical Spinal Cord Infarction

et al. 2017

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BackgroundLack of timely recognition and neuroimaging may be a barrier to reperfusion efforts in acute spinal cord infarction.MethodsWe performed a retrospective study of patients diagnosed with acute non-surgical spinal cord infarction at our tertiary academic center from 2001 to 2015. We studied parameters associated with time from symptom onset to initial hospital presentation and magnetic resonance imaging (MRI) of the spinal cord.ResultsWe identified 39 patients among whom anterior spinal artery syndrome was the most frequent presentation (87.2%) and atherosclerosis the most common etiology (56.4%). Nearly, half of the patients presented to the emergency department on the same day of symptom onset (48.7%) but only nine (23.1%) within the first 6 h. Average time from symptom onset to spinal cord MRI was 3.2 days. We could not identify clinical, radiological, or outcome patterns associated with early vs. delayed presentation and imaging.DiscussionOur study found a time lag from symptom onset to hospital presentation and spinal cord MRI in patients with acute spinal cord infarction. These findings point at low clinical suspicion of spinal cord syndromes and limited recognition as a potentially treatable medical emergency.

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“…While tissue plasminogen activator (tPA) may be considered for acute infarct. 13 Its accepted use is within a maximum of 4.5 hours after symptoms onset. By the time our patient presented to our care, she was outside of the window for tPA administration.…”

Section: Discussionmentioning

confidence: 99%

Rapidly Progressive Paraplegia in an 11-Year-Old Girl: A Case of Spinal Cord Infarction and Expected Imaging Findings

Neth

Hewitt

Edlund

et al. 2020

Child Neurology Open

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Rapidly progressive non-traumatic paraplegia in a child is uncommonly encountered in clinical practice, but is an important presentation to consider given the potential for significant morbidity. We present the case of an 11-year-old girl who was found to have hyperacute paraplegia due to spinal cord infarction. We discuss the appropriate workup, differential diagnosis in children and how this relates to adults; and describe the prognosis and current state of management options for spinal cord infarction.

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Repeated early thrombolysis in cervical spinal cord ischemia

Cited by 19 publications

References 11 publications

Acute ischemic myelopathy treated with intravenous thrombolysis: Four new cases and literature review

Acute ischemic myelopathy treated with intravenous thrombolysis: Four new cases and literature review

Delayed Hospital Presentation and Neuroimaging in Non-surgical Spinal Cord Infarction

Rapidly Progressive Paraplegia in an 11-Year-Old Girl: A Case of Spinal Cord Infarction and Expected Imaging Findings

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