Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients

Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital f...

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Veröffentlicht in:Neurología (Barcelona, English ed. ) Jg. 38; H. 6; S. 391 - 398
Hauptverfasser: Ros Castelló, V., Sánchez Sánchez, A., Natera Villalba, E., Gómez López, A., Parra, P., Rodríguez Jorge, F., Buisán Catevilla, J., García Barragán, N., Masjuan, J., Corral, I.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Spain Elsevier España, S.L.U 01.07.2023
Elsevier España
Schlagworte:
Cerebrovascular disease
Enfermedad cerebrovascular
Infarto medular
Internal Medicine
Magnetic resonance imaging
Neurology
Prevención secundaria
Resonancia magnética
Secondary prevention
Spinal cord infarction
Resonancia magnética
Magnetic resonance imaging
Prevención secundaria
Secondary prevention
Infarto medular
Spinal cord infarction
Cerebrovascular disease
Enfermedad cerebrovascular
ISSN:2173-5808, 2173-5808
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Abstract Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3–70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05). Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis. El infarto medular es una entidad infrecuente y con elevada morbilidad. El diagnóstico puede resultar difícil y el tratamiento óptimo sigue siendo controvertido. Existen pocas series de casos publicadas. Estudio retrospectivo de infarto medular en un hospital terciario desde 1999 a 2020. Se evaluaron la etiología, las características clínicas, radiológicas, terapéuticas y pronósticas. Se incluyeron 41 pacientes (58,5% varones, edad media 61 ±17 años). Treinta y un pacientes (75,6%) presentaban factores de riesgo vascular (FRV). Presentaron déficit motor (39, 95,1%), dolor (20, 48,8%), déficit sensitivo (33, 80,4%) y alteración autonómica (24, 58,5%). Se realizó resonancia magnética (RM) en 37 pacientes (90,2%). En los 12 pacientes con secuencias de difusión, esta estaba alterada en 10. La localización más afectada fue la dorsal (68,2%). Se realizó estudio vascular en 33 pacientes (80,4%). Las etiologías más frecuentes fueron disección aórtica en 6, ateroesclerosis demostrada en estudio vascular en 6, embolia fibrocartilaginosa en 6, posquirúrgico en 5 e hipotensión en 4. El mecanismo etiológico quedó sin filiar en 12 pacientes (29,3%), 9 presentaban FRV. Al final del periodo de seguimiento (mediana 24 meses, rango intercuartílico 3-70), 12 pacientes (29,2%) presentaban deambulación autónoma. La presencia de FRV y la paraparesia se asociaron significativamente a peor pronóstico (p < 0,05). El infarto medular es una patología con una etiología variada, que en muchos de los pacientes queda sin resolver. El pronóstico funcional a largo plazo es malo y depende de las características basales del paciente y de la forma de presentación clínica. La RM, especialmente las secuencias de difusión, es útil en el diagnóstico precoz.
AbstractList AbstractIntroductionSpinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. MethodsWe conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. ResultsForty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3–70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05). DiscussionSpinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.
Introduction: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. Methods: We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. Results: Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3–70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05). Discussion: Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis. Resumen: Introducción: El infarto medular es una entidad infrecuente y con elevada morbilidad. El diagnóstico puede resultar difícil y el tratamiento óptimo sigue siendo controvertido. Existen pocas series de casos publicadas. Métodos: Estudio retrospectivo de infarto medular en un hospital terciario desde 1999 a 2020. Se evaluaron la etiología, las características clínicas, radiológicas, terapéuticas y pronósticas. Resultados: Se incluyeron 41 pacientes (58,5% varones, edad media 61 ±17 años). Treinta y un pacientes (75,6%) presentaban factores de riesgo vascular (FRV). Presentaron déficit motor (39, 95,1%), dolor (20, 48,8%), déficit sensitivo (33, 80,4%) y alteración autonómica (24, 58,5%). Se realizó resonancia magnética (RM) en 37 pacientes (90,2%). En los 12 pacientes con secuencias de difusión, esta estaba alterada en 10. La localización más afectada fue la dorsal (68,2%). Se realizó estudio vascular en 33 pacientes (80,4%). Las etiologías más frecuentes fueron disección aórtica en 6, ateroesclerosis demostrada en estudio vascular en 6, embolia fibrocartilaginosa en 6, posquirúrgico en 5 e hipotensión en 4. El mecanismo etiológico quedó sin filiar en 12 pacientes (29,3%), 9 presentaban FRV. Al final del periodo de seguimiento (mediana 24 meses, rango intercuartílico 3-70), 12 pacientes (29,2%) presentaban deambulación autónoma. La presencia de FRV y la paraparesia se asociaron significativamente a peor pronóstico (p < 0,05). Discusión: El infarto medular es una patología con una etiología variada, que en muchos de los pacientes queda sin resolver. El pronóstico funcional a largo plazo es malo y depende de las características basales del paciente y de la forma de presentación clínica. La RM, especialmente las secuencias de difusión, es útil en el diagnóstico precoz.
Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05). Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.
Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published.INTRODUCTIONSpinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published.We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed.METHODSWe conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed.Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05).RESULTSForty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05).Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.DISCUSSIONSpinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.
Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3–70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05). Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis. El infarto medular es una entidad infrecuente y con elevada morbilidad. El diagnóstico puede resultar difícil y el tratamiento óptimo sigue siendo controvertido. Existen pocas series de casos publicadas. Estudio retrospectivo de infarto medular en un hospital terciario desde 1999 a 2020. Se evaluaron la etiología, las características clínicas, radiológicas, terapéuticas y pronósticas. Se incluyeron 41 pacientes (58,5% varones, edad media 61 ±17 años). Treinta y un pacientes (75,6%) presentaban factores de riesgo vascular (FRV). Presentaron déficit motor (39, 95,1%), dolor (20, 48,8%), déficit sensitivo (33, 80,4%) y alteración autonómica (24, 58,5%). Se realizó resonancia magnética (RM) en 37 pacientes (90,2%). En los 12 pacientes con secuencias de difusión, esta estaba alterada en 10. La localización más afectada fue la dorsal (68,2%). Se realizó estudio vascular en 33 pacientes (80,4%). Las etiologías más frecuentes fueron disección aórtica en 6, ateroesclerosis demostrada en estudio vascular en 6, embolia fibrocartilaginosa en 6, posquirúrgico en 5 e hipotensión en 4. El mecanismo etiológico quedó sin filiar en 12 pacientes (29,3%), 9 presentaban FRV. Al final del periodo de seguimiento (mediana 24 meses, rango intercuartílico 3-70), 12 pacientes (29,2%) presentaban deambulación autónoma. La presencia de FRV y la paraparesia se asociaron significativamente a peor pronóstico (p < 0,05). El infarto medular es una patología con una etiología variada, que en muchos de los pacientes queda sin resolver. El pronóstico funcional a largo plazo es malo y depende de las características basales del paciente y de la forma de presentación clínica. La RM, especialmente las secuencias de difusión, es útil en el diagnóstico precoz.
Author Rodríguez Jorge, F.
Natera Villalba, E.
Sánchez Sánchez, A.
Buisán Catevilla, J.
Masjuan, J.
García Barragán, N.
Gómez López, A.
Parra, P.
Corral, I.
Ros Castelló, V.
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Keywords Resonancia magnética
Magnetic resonance imaging
Prevención secundaria
Secondary prevention
Infarto medular
Spinal cord infarction
Cerebrovascular disease
Enfermedad cerebrovascular
Language English
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Snippet Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment....
AbstractIntroductionSpinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding...
Introduction: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the...
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SubjectTerms Cerebrovascular disease
Enfermedad cerebrovascular
Infarto medular
Internal Medicine
Magnetic resonance imaging
Neurology
Prevención secundaria
Resonancia magnética
Secondary prevention
Spinal cord infarction
Title Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients
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