Ischemic spinal stroke

Ischemic spinal stroke
Ischemic spinal stroke is a necrosis of a fragment of the spinal cord that occurs abruptly and immediately becomes acute. The disease is characterized by impaired blood supply to certain tissues. The reason for the latter is the blockage of blood clots. In addition to blood clots, the cause may be atherosclerotic plaques, as well as compression of the arteries from the outside.

The content of the article:
Causes of ischemic spinal stroke
Symptoms of ischemic spinal stroke
Diagnosis of ischemic spinal stroke
Treatment of ischemic spinal stroke
Prognosis and prevention of ischemic spinal stroke
Ischemic spinal stroke
Ischemic spinal stroke is characterized by the onset of paresis (or paralysis) of the upper and lower extremities, as well as a possible disorder of the functioning of the bladder or rectum. Usually, the diagnosis is made after the studied symptoms and the results obtained after an MRI or CT scan of the spinal cord.

If we talk about conservative treatment, it will focus on methods to improve blood supply in the area that has been affected by a stroke. In addition, the treatment is aimed at eliminating the causes that led to blood flow failures. In case of ineffective conservative treatment, surgical treatment is prescribed.

According to statistics, spinal stroke occurs only in 1% of patients suffering from impaired blood circulation of the central nervous system. This disease can happen to people of all ages. To date, ischemic spinal stroke is inherent in more and more people under the age of 35, in an equal percentage ratio between men and women.

Causes of ischemic spinal stroke
The causes of ischemic spinal stroke are divided into three categories:

Causes associated with damage to the heart and blood vessels (occurs in 20-22% of cases).
Causes of compression of vessels from the outside (occurs in 75% of cases of the disease).
Causes arising as a result of complications after medical manipulations (5-7%).
Cases of damage to the heart and cardiovascular system are explained by the presence of anomalies of their structure, which is often congenital. In addition, lesions may be acquired in nature (most often, lesions of the vessels themselves).

The cause of the congenital disorder is usually underdevelopment of the spinal vessels, abnormalities in the normal development of the aorta, all kinds of aneurysms and varicose veins.

Among the most common causes of acquired lesions:

atherosclerosis of vascular walls;
blockage of arterial lumen by blood clots;
low blood pressure in the vessels that feed the spinal cord;
heart failure;
myocardial infarction.
As is known, compression from the outside occurs by squeezing the aorta or nearby vessels. Compression may occur due to the formation in the chest or abdominal cavity. The latter includes pregnancy, an increase in the size of lymph nodes due to the spread of a tumor (metastases) or lymphogranulomatosis.

If we talk about compression of the radicular cerebral arteries, then most often this occurs with a vertebral hernia, spinal cord tumor, or even with vertebral fractures.

In addition, ischemic spinal stroke develops as a consequence of improper technique during surgical intervention in the spine or nearby tissues. Often such an incorrect technique is considered to be prolonged squeezing with a surgical clamp, which is used to stop arterial bleeding. The cause of an acute malfunction in blood circulation can be, for example, spinal anesthesia or blockade of the spinal nerve roots (this usually happens with sciatica).

Symptoms of ischemic spinal stroke
All symptoms of ischemic spinal stroke can be divided into 4 stages:

The Harbinger stage;
Stage of stroke development;
The stage of reverse development;
The stage of the remaining phenomena.
Let’s take a closer look at each of the stages.

The Harbinger stage
The first stage, the harbinger stage, can last from a few minutes to several months. A short stage is inherent in the case of unexpected and rapid blockage of blood vessels by blood clots or in the case of a clamped artery, which is often observed with spinal injury.

Speaking of a longer period of this stage, a gradual and slow cessation of blood circulation is assumed (for example, in the case of tumor growth or with an increase in the size of an atherosclerotic plaque).

The preceding symptoms of this disease may be:

occasional lameness;
pain in the spine area;
numbness of the limbs;
feeling of crawling “goosebumps”;
discomfort in the direction of branching of the spinal type of roots.
Intermittent lameness in neurology is a condition in which the patient feels characteristic numbness of the lower extremities, weakness during prolonged stay on his feet or a long walk. The latter is explained by the resulting oxygen starvation in the spinal region, which is responsible for the mobility of the legs. In addition, the cause of such lameness may be poor blood circulation in the vessels.

Stroke development
The process of developing an ischemic spinal stroke will always depend on the causes that caused the spinal cord blood circulation to stop. If the latter occurred due to a detached blood clot, then the symptoms will develop literally within the next few minutes. In other cases, the symptoms will finally manifest within a few hours.

The further symptoms of a developing ischemic stroke will depend on which vessel stopped the flow of blood to the spinal cord. If there is a blockage of the spinal artery, then paralysis of the limbs begins, the normal activity of the bladder and intestines is disrupted, the skin becomes not as sensitive as before, especially on the hands and feet.

If the main focus of the stroke is concentrated in the cervical spinal cord, then the patient is characterized by a sluggish type of paralysis in the upper extremities, which is usually accompanied by a decrease in muscle tone. There may also be spastic paralysis in the lower extremities, which is characterized by an increase in muscle tone. In case of damage to the thoracic parts of the spinal cord, paresis of the legs or sluggish paresis of the legs with a delay in feces begins (if the focus is localized in the lumbosacral region).

Reverse development
The stage of reverse development of symptoms begins a month after the onset of the disease. This stage is characterized by a fragmentary restoration of blood supply in the area that was damaged. Recovery occurs due to the influx of blood into the arteries from other large vessels. There is also a restoration of the functions of neurons that remained as intact as possible in the focus of the stroke.

As for the reverse development, it is characterized by a slow decrease in the sensitivity disorder, the return of some movements inherent in the limbs and the resumption of the pelvic organs. The speed of this process, as well as the extent of recovery of the lost function, will depend on the location where the focus of ischemic stroke is concentrated in the spinal cord.

The stage of residual phenomena
The stage of residual phenomena is manifested in patients 2-3 hours after the onset of the first symptoms of the disease. This stage is characterized by the presence of various neurological disorders that do not have pronounced dynamics.

Diagnosis of ischemic spinal stroke
It is usually difficult to diagnose an ischemic spinal stroke, because in its appearance it resembles polio, multiple sclerosis, syringomyelia, a deviation in the structure of the cerebellum.

It is very important during the diagnosis to study in detail the previous factors and the rate of development of symptomatic signs. All the signs will help to determine the cause of the development of circulatory disorders in the spinal cord.

Understanding which segment of the spinal cord is responsible for certain movements or for the sensitivity of parts of the body, allows you to determine the localization of the focus of stroke.

To confirm the diagnosis of ischemic spinal stroke, an MRI or CT scan of the spinal cord is performed, myelography, spondylography or electrophysiological examination may be prescribed.

By means of angiography, it is possible to detect which lumen of the blood vessel has been narrowed, or which of them has become clogged. With the help of CT and MRI, you can very accurately determine the level of the focus of a stroke that has affected the spinal cord.

Myelography is an excellent diagnostic method that allows you to detect compression of blood vessels by a tumor located in the spinal cord, as well as an intervertebral hernia or fragments of a vertebra (often after injury). Such electrophysiological studies as ENG and EMG are carried out in order to determine failures in muscle innervation.

Treatment of ischemic spinal stroke
The main goal of the treatment of ischemic stroke will be to improve the blood supply to the spinal cord in the area affected by the stroke. In addition, it is very important to eliminate the factors that cause circulatory disorders and restore spinal functions lost during the disease.

It is possible to improve blood circulation by increasing blood flow in nearby arteries. For this purpose, doctors usually prescribe vasodilators that can improve the flow of blood through the vessels. In addition, decongestants are often prescribed, as well as those that have a venotonizing effect. Mandatory in drug therapy will be the use of drugs that can increase the resistance of spinal tissue to oxygen starvation.

Usually, the root causes of circulatory disorders can be eliminated both conservatively and operationally. The choice of treatment will depend on the cause that contributed to the development of this disease.

If a blood vessel lumen is blocked by a thrombus, anticoagulants or antiplatelet agents are usually prescribed. If the cause of an ischemic stroke is a clamped artery with an intervertebral hernia, then to restore normal blood circulation, it is recommended to wear an orthopedic corset, perform therapeutic and preventive physical education and attend physiotherapy.

If conservative treatment is ineffective, then surgical treatment is performed. Surgical intervention is indicated in the case of compression of vessels by a vertebral tumor.

At the stage of reverse development, it is still possible to restore the lost spinal functions. For this purpose, manual therapy, massage, physical therapy, various physiotherapy procedures are prescribed and sent to medical sanatoriums.

Prognosis and prevention of ischemic spinal stroke
The prognosis for ischemic spinal stroke will depend, first of all, on the area of the lesion of the spinal cord, as well as on its localization. In more than half of the cases of timely first aid, as well as with proper rehabilitation, the patient recovers completely. Very often there is a complete restoration of previously lost functions.

Other cases of ischemic spinal stroke subsequently lead to neurological disorders such as paresis and paralysis, malfunctions in the defecation or urination system. Therefore, often a person who has had this disease becomes disabled.

Fatal outcomes are diagnosed only in some cases when a spinal tumor is inoperable, as well as with serious aortic injuries, with complications from the cardiovascular or urinary system.

Prevention of ischemic spinal stroke is understood as:

timely detection and treatment of cardiovascular diseases;
control of cholesterol levels in the blood;
prevention of the onset of atherosclerosis, osteochondrosis;
prevention of protrusion and intervertebral hernia;
the fight against obesity;
an active lifestyle.
If a person has identified at least one symptom of this disease, you should immediately consult a doctor.

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