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

Demyclinating lesions of the spinal cord, including multiple sclerosis as well as other less common diseases, probably represent the etiology of a substantial proportion of all idiopathic myelopathies. Magnetic resonance imaging (MRI) has made major advances in the diagnosis and characterization of demyclinating disease. Infections of the spine may have severe consequences and, if detected early, are usually treatable processes. Osteomyelitis and epidural abscesses have characteristic imaging findings. Poor outcomes are more often due to delays in clinical presentation or the debilitated condition of the patients than to limitations in the accuracy of MRI diagnosis. Cavitary lesions of the spinal cord were among the first applications in which MRI proved its superiority to previously available techniques. Accurate diagnosis of these lesions involves detecting characteristics findings and relating these observations to the clinical history. Spinal cord infarction is relatively rare due to the extensively collateralized blood supply to the spinal canal. However, aortic aneurysms and the surgery for these lesions places the blood supply of the distal spinal cord and conus at risk. The syndrome of postoperative spinal cord infarction has characteristic clinical findings. However, MRI may contribute to distinguishing transient ischemia from true infarction and to predicting the severity of the final deficit.
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PMID:Inflammation, infection, cavitary disorders, and ischemia. 157 87

Spinal cord infarction is a rare entity of varying etiology although most often associated with atherosclerotic aortic disease. Definitive diagnosis of (idiopathic) spinal cord infarction in the acute stage and in the absence of demonstrable predisposing factors is not always possible even with MRI. Diffusion-weighted MRI (dwMRI) may provide valuable information in the evaluation of spinal cord ischemia. A 45-year-old woman presented with idiopathic spinal cord infarction manifesting as sudden onset of paraparesis and sphincter dysfunction. Both T2-weighted and line-scan dwMRI revealed hyperintense signals in the dorsal part of the spinal conus. Apparent diffusion coefficient values were significantly low in the lesion, suggesting cytotoxic edema compatible with acute ischemia. The clinical course and other radiographic findings were also compatible with idiopathic spinal cord infarction. Diffusion-weighted MRI is an important diagnostic tool for examining patients with suspected spinal cord ischemia.
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PMID:Spinal cord infarction demonstrated by diffusion-weighted magnetic resonance imaging. 1592 84

Spinal cord infarction is a rare complication following thoracic surgery. We present a case who developed paraplegia on the first postoperative day of thoracotomy. A 76-year-old man with a history of atherosclerotic cardiovascular disease was operated for bronchial carcinoma. An epidural infusion of ropivacaine and sufentanil was used for postoperative pain. Eight hours after the surgery, he had an episode of hypotension and respiratory depression. One hour later, he described paraplegia and Ischemia of the spinal cord was found on MRI. There was no recovery during the follow-up.
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PMID:Anterior spinal artery syndrome after thoracic surgery. 1639 81

Spinal cord infarction in children is a rare condition that is becoming more widely recognized. There are few reports in the pediatric literature characterizing etiology, diagnosis, treatment, and prognosis. The risk factors for pediatric ischemic spinal cord infarction include obstruction of blood flow associated with cardiovascular compromise or malformation, iatrogenic or traumatic vascular injury, cerebellar herniation, thrombotic or embolic disease, infection, and vasculitis. In many children, the cause of spinal cord ischemia in the absence of vertebral fracture is unknown. Imaging diagnosis of spinal cord ischemia is often difficult, due to the small transverse area of the cord, cerebrospinal fluid artifact, and inadequate resolution of magnetic resonance imaging. Physical therapy is the most important treatment option. The prognosis is dependent on the level of spinal cord damage, early identification and reversal of ischemia, and follow-up with intensive physical therapy and medical support. In addition to summarizing the literature regarding spinal cord infarction in children without vertebral fracture, this review article adds two cases to the literature that highlight the difficulties and controversies in the management of this condition.
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PMID:Ischemic spinal cord infarction in children without vertebral fracture. 1743 2

Spinal cord infarction is much rarer than cerebral stroke, but its early recognition is important as it may signify serious aortic conditions. The most frequent type is anterior spinal artery syndrome, presenting with bilateral weakness (usually paraparesis), impairment of spinothalamic sensation and preservation of deep sensation. Depending on its level, it may present with respiratory dysfunction. More rarely, posterior infarcts sparing spinothalamic sensation but involving lemniscal sensation may be encountered. Unilateral, central or transverse infarction may also be seen probably on account of different mechanisms. Other rarer forms of spinal ischemia also include spinal TIAs, venous infarction, fibrocartilaginous embolism and decompression sickness.
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PMID:Spinal cord syndromes. 2237 94

The major radicular artery eponymically named "Adamkiewicz's artery" (AKA) is an important vessel supplying the spinal cord, especially the lumbar enlargement. This report emphasizes the importance of anatomical knowledge of this artery and highlights the concept of the potential risk of neurological complications during different procedures: spine orthopedic/neurosurgery, aortic repair (vascular surgery) and endovascular selective embolizations performed by interventional neuro/radiologists. Anatomical considerations are made on the spinal cord arterial circulation with a special focus on the AKA. Our review of the literature considered this anatomical element essential to compare the potential risk of spinal cord ischemic damage during orthopedic/neurosurgical spine procedures, aortic vascular surgery repair procedures and endovascular selective arterial embolizations. Evaluation of the endovascular selective arterial spine embolization risk was based on our series of 410 embolization procedures. Spinal cord infarction and transient or permanent paraplegia may result from inadvertent interruption of the AKA. The presence of intersegmental collaterals may decrease the risk of spinal cord ischemia: this is an important element to bear in mind that may help in spine surgery or aortic repair procedures performed by vascular surgeons. Nevertheless, during aortic repair (open surgery or stent-graft procedures) interruption of bilateral segmental arteries at multiple consecutive levels including that of the AKA may occur thereby increasing the ischemic spinal cord risk, annulling the benefit of intersegmental collaterals. Accidental embolizations of the AKA during endovascular spine procedures (i.e. selective arterial embolizations) performed by interventional neuro/radiologists will cause an almost certain spinal cord infarction due to the consequent embolizations of the anterior spinal artery (ASA).
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PMID:A Little Talk on Adamkiewicz's Artery. Some Practical Considerations on the Pre-Operative Identification of this Artery Starting from a Single Team Experience in Pre-Surgical Selective Embolization of Vascularized Spinal Lesions. 2414 43

Spinal cord infarction is extremely rare in children, and, similar to cerebrovascular infarcts, the pathogenesis is different from adults. Spinal cord infarcts are most commonly reported in adults in the context of aortic surgery; in children, the etiology is frequently unknown. Fibrocartilaginous embolization is a potential cause of spinal cord infarct in both populations. It is a process that occurs when spinal injury has resulted in disc disease, and subsequently disc fragments embolize to the cord, resulting in ischemia and/or infarction. In this report, we present a 16-year-old athlete who presented with symptoms of acute myelopathy after a period of intense exercise. Our original concern was for an inflammatory process of the spinal cord; however, given her history of competitive tumbling and degenerative disc changes on her initial spine magnetic resonance imaging scan, diffusion-weighted imaging was performed, which demonstrated acute spinal cord infarction. Unlike many cases of spinal cord infarction, our patient was fortunate to make a near-complete recovery. This case highlights the importance of recognizing rare causes of spinal cord pathology and considering infarction in the differential diagnosis of acute myelopathy because management and prognosis varies.
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PMID:Posterior spinal cord infarction due to fibrocartilaginous embolization in a 16-year-old athlete. 2495 91

Paraplegia after posterior fossa surgery is a rare and devastating complication. The authors reviewed a case of paraplegia following Chiari decompression and surveyed the literature to identify strategies to reduce the occurrence of such events.An obese 44-year-old woman had progressive left arm pain, weakness, and numbness and tussive headaches. MRI studies revealed a Chiari I malformation and a cervicothoracic syrinx. Immediately postoperatively after Chiari decompression the patient was paraplegic, with a T6 sensory level bilaterally. MRI studies revealed equivocal findings of epidural hematoma at the site of the Chiari decompression and in the upper thoracic region. Surgical exploration of the Chiari decompression site and upper thoracic laminectomies identified possible venous engorgement, but no hematoma. Subsequent imaging suggested a thoracic spinal cord infarction. Possible explanations for the spinal cord deficit included spinal cord ischemia related to venous engorgement from prolonged prone positioning in an obese patient in the chin-tucked position. At 6.5 years after surgery the patient had unchanged fixed motor and sensory deficits.Spinal cord infarction is rare after Chiari decompression, but the risk for this complication may be increased for obese patients positioned prone for extended periods of time. Standard precautions may be insufficient and intraoperative electrophysiological monitoring may need to be considered in these patients.
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PMID:Spinal cord infarction with resultant paraplegia after Chiari I decompression: case report. 3186 Aug 15

Spinal cord infarction is reported to account for less than 1% of all strokes and is a relatively rare disease. In recent years, thoracic endovascular aortic repair (TEVAR) has become a common treatment for aortic aneurysms, and spinal cord ischemia is one of its complications. Most cases occur in the perioperative period; however, a few cases have been reported in the chronic stage. Here, we report a case of spinal cord infarction, 6 months after TEVAR. A 77-year-old man experienced sudden onset paraparesis following dumbbell exercises and defecation. He had a history of an infectious thoracoabdominal aortic aneurysm treated by TEVAR 6 months prior. Paralysis and disturbance of the thermal pain and tactile sensations of the lower limbs were observed, but proprioception and deep sensation were preserved. Computed tomography (CT) showed no evidence of intraspinal hemorrhage, new aortic dissection, or endoleak around the aortic stent placed from Th11 to L3. Magnetic resonance imaging (MRI) showed intramedullary hyperintensity from Th11 to the conus 2 days after onset. Anticoagulant therapy and rehabilitation were performed, and the lower-limb muscle strength gradually improved. After aortic stenting, particularly including the level of the Adamkiewicz artery, the risk of spinal cord ischemia must be monitored, because spinal circulation depends on collateral circulation.
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PMID:Spinal cord infarction six months after thoracic endovascular aortic repair- A case report. 3296 61