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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A review is given on the current diagnosis and treatment of spinal vascular malformations with special emphasis on the use of selective spinal angiography. Spinal vascular malformations are mostly encountered within the thoraco-lumbar segment of the spinal cord. Typical clinical symptoms are due to either progressive myelopathy or hemorrhage (subarachnoidal hemorrhage). The prognosis of untreated spinal angiomas is poor. Therefore, therapeutic measures are aiming to prevent bleeding of angiomas resulting in subarachnoidal hemorrhages or hematomyelia or to prevent spinal cord ischemia due to compression. Using selective spinal angiography, spinal angiomas can now be treated successfully by complete surgical extirpation or embolization procedures. The evaluation of radicular myelopathies and subarachnoidal hemorrhages of unknown origin has also considerably benefited from this technique. It is concluded that early diagnosis of spinal vascular malformations is of crucial importance for good therapeutical results.
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PMID:[Vascular malformations of the spinal cord. Diagnosis and therapy]. 96 22

The authors report experiments designed to test the effect of regional ischemia induced by selective vascular ligations and anterior compression of the cervical cord at two adjacent segments (C-4, C-5) in the same dog. They conclude that local ischemia of the cervical cord, caused by local deformation, when superimposed on a regional reduction in spinal cord blood flow, accounts for the myelopathy of cervical spondylosis whether produced experimentally in animals or occurring naturally in man.
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PMID:Experimental cervical myelopathy. Effects of ischemia and compression of the canine cervical spinal cord. 114 88

We studied 9 patients with clinical evidence of spinal cord ischemia or infarction who had altered vesicourethral function. Of the patients 6 had some preservation of bladder and lower extremity sensation, a clinical pattern consistent with the anterior spinal artery syndrome. A total of 3 patients had a clinical picture more consistent with complete transverse myelopathy, since they had no preservation of bladder or lower extremity sensation. Despite sensory levels well above the sacral spinal cord segments, 6 patients had detrusor areflexia (4 with bethanechol supersensitivity and 4 with neuropathic changes in the perineal electromyograph) indicating longitudinal spinal cord involvement. Three patients had detrusor hyperreflexia with vesicosphincter dyssynergia, indicating some preservation of the sacral spinal cord. In 6 patients appreciation of pinprick in the lower extremities was absent or decreased but light touch or position sense was preserved. Bladder sensation was dissociated in 4 of these 6 patients, since they had perception of bladder distention but loss of urge to void. These findings indicate that bladder distention is a sensory modality probably mediated via the posterior spinal cord, while the sense of urgency is probably conveyed by the anterior spinal cord.
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PMID:Effect of spinal cord ischemia on vesicourethral function. 140 39

Aortic diseases in particular aneurysms may be accompanied by spinal ischemia occurring either spontaneously or as complications of surgical interventions. Surgery of the abdominal or thoraco-abdominal aorta is followed in 5 to 15% by ischemia of the spinal cord, in exclusively abdominal interventions in 1.5%. Clinical manifestation depends largely on anatomy of the spinal vessels. If complete transverse myelopathy does not occur, presentation as anterior or posterior arterial ischemic syndrome is common. Other forms of myelopathy are rare. Perfusion deficits through intercostal and lumbar arteries are important in pathogenesis. The great radicular artery is particularly important. Ischemia occurs after hypotensive episodes (ruptured aneurysm) intraoperative clamping of the suprarenal aorta or by occlusion (thrombotic, arterio-arterial embolism). Careful surgical techniques are important for prevention of these neurologic complications. Possibilities for treatment and chances for spontaneous recovery of established spinal-cord lesions are poor.
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PMID:[Spinal lesions in surgery of the aorta]. 141 Sep 90

Four patients presented with a distinctive syndrome of "numb, clumsy hand" and tactile agnosia. Myelography and computed tomographic myelography (CTM) of the cervical spine documented major spondylotic compressive lesions mainly between the C3 and C5 levels. The cortical responses of dermatomal somatosensory evoked potentials (DSEPs) revealed progressively prolonged peak latencies and progressively decreased amplitudes of early components from C6 to C8 dermatomal stimulation. In comparison, the C5 and L2 DSEPs were affected to a lesser extent. This finding suggests that high cervical cord compression may produce dysfunction of the dorsal column caudal to the direct compressive sites. In other words, the funiculus cuneatus of C6-8 cord is most affected in high cervical myelopathy. Moreover, the funiculus cuneatus is within the border zone susceptible to an overall reduction in blood flow. We conclude therefore, that ischemia secondary to cord compression is the pathophysiology resulting in this unique syndrome of "numb, clumsy hands" and tactile agnosia.
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PMID:"Numb, clumsy hands" and tactile agnosia secondary to high cervical spondylotic myelopathy: a clinical and electrophysiological correlation. 763 77

A case of acute aortic dissection (AAD) presenting as sudden, transient paraplegia and severe back pain is reported. The patient was a 66-year-old male with a 10-year-history of hypertension. The pain characteristically migrated from the back to the neck and then returned to the back. He showed complete transverse myelopathy at the level of the 9th thoracic cord. Computed tomography disclosed internal displacement of aortic intimal calcifications, without abnormalities in the spinal canal, and myelography showed no spinal canal block or stenosis. Electrocardiography and chest x-ray indicated nonspecific changes of high amplitudes and mild cardiomegaly, respectively. Together, these findings suggested acute aortic dissection with spinal cord ischemia. The initial systolic blood pressure of 220 mmHg was lowered with medication, and the pain was controlled with morphine. He recovered fully and was discharged 80 days after the onset of symptoms, with no neurological deficits. AAD carries a very poor prognosis unless treated immediately. Therefore, it is very important to promptly differentiate this disorder from spinal vascular conditions that also produce back pain and paraparesis.
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PMID:Transient paraplegia caused by acute aortic dissection--case report. 169 75

Nontraumatic spinal cord ischemia is uncommon, especially when the cervical cord is involved. We present an elderly man who sustained acute occlusion of the anterior spinal artery at a high cervical level. This was followed by a respiratory arrest due to the paralysis of the diaphragm and chest wall muscles. A review of the vascular supply to the cord and of nontraumatic ischemic myelopathy is provided.
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PMID:Cervical anterior spinal artery syndrome associated with cardiopulmonary arrest. 186 1

Three patients with spinal dural arteriovenous fistula presented with acute and/or progressive myelopathy. The thoracic cord was focally enlarged and poorly defined on MR images in two of the patients. One individual showed focal cord atrophy, and one demonstrated abnormal intrathecal vessels. In all patients MR studies revealed cord enhancement after IV administration of gadopentetate dimeglumine. The MR findings are believed to represent disruption of the blood-cord barrier associated with cord ischemia and/or infarction, which, in turn, is caused by venous stasis resulting from the fistula. The diagnosis in each case was confirmed by the combined results of myelography, spinal arteriography, and surgery. Surgical excision or embolization of the fistula produced a poor return of lost function but an arrest in the progression of paresis. One of the patients had constant severe back and leg pain postoperatively, and a follow-up MR study 5 months after surgery showed focal atrophy and persistent enhancement of the thoracic cord. The patient with preoperative focal cord atrophy had an MR examination 1 year prior to surgery, which revealed enhancement of the cord similar to that seen on the immediate preoperative MR study. This patient also had severe pain in the back and lower extremities preoperatively, which accompanied her progressive paraparesis. It is believed that long-standing enhancement of the spinal cord in patients with dural arteriovenous fistula probably results from chronic progressive venous ischemia, which may be irreversible and cause pain of a central type.
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PMID:Venous infarction of the spinal cord resulting from dural arteriovenous fistula: MR imaging findings. 188 56

MR images of the thoracic spinal cord were made in 24 patients who developed signs and symptoms of spinal cord ischemia or infarction following surgery for a thoracoabdominal aortic aneurysm. Findings consisted primarily of four different patterns of signal abnormalities in the distribution of the anterior spinal artery. These abnormalities were identified as types A-D, depending on the degree of involvement of the gray matter and surrounding white matter. We found good correlation between the distribution of the signal abnormalities in the cord, the severity of the neurologic deficits, and the clinical outcome. MR is the imaging method of choice for diagnosing spinal cord ischemia or infarction. A thorough knowledge of the spinal cord arterial territories is crucial for characterizing ischemic MR signal abnormalities and for differentiating them from other causes of myelopathy.
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PMID:Spinal cord ischemia after resection of thoracoabdominal aortic aneurysms: MR findings in 24 patients. 212 Oct 5

MR images of the thoracic spinal cord were made in 24 patients who developed signs and symptoms of spinal cord ischemia or infarction following surgery for a thoracoabdominal aortic aneurysm. Findings consisted primarily of four different patterns of signal abnormalities in the distribution of the anterior spinal artery. These abnormalities were identified as types A-D, depending on the degree of involvement of the gray matter and surrounding white matter. We found good correlation between the distribution of the signal abnormalities in the cord, the severity of the neurologic deficits, and the clinical outcome. MR is the imaging method of choice for diagnosing spinal cord ischemia or infarction. A thorough knowledge of the spinal cord arterial territories is crucial for characterizing ischemic MR signal abnormalities and for differentiating them from other causes of myelopathy.
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PMID:Spinal cord ischemia after resection of thoracoabdominal aortic aneurysms: MR findings in 24 patients. 212 84


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