Spinal cord ischemia

Cuevas, P., Carceller-Benito, F. and Rcimers, D. (1989). Administration of bovine SOD prevents sequelae of spinal cord ischemia in rabbit. Anat. Embryol. 179, 251-255. 

Shohami E, Jacobs TP, Hallenbeck JM, Feuerstein G. 1987. Increased thromboxane A2 and 5-HETE production following spinal cord ischemia in the rabbit. Prostaglandins Leukot Med 28 169-181. 

Noa, et al. Protective effect of D-003 on experimental spinal cord ischemia... 

In contrast to disc embolism, most patients with thrombotic or embolic infarctions show at least partial recovery in the further course of the disease. Nevertheless, depending on the efforts in diagnostic work-up, the cause of spinal cord ischemia often remains undefined or speculative. 

Moreover, analysis of data coming from greater MR series and our own observations reveal no predominance of infarcts in the upper and mid-thoracic region (Mawad et al. 1990 Weidauer et al. 2002). Thus, the concept of a vulnerable watershed zone at T4 is no longer valid in acute spinal cord ischemia. 

Spinal angiography remains the gold standard in spinal vascular malformations and can help to elucidate the underlying pathology of acute spinal cord ischemia in selected cases (Di Chiro and Wener 1973 Djindjian et al. 1970 Lasjaunias et al. 2001). 

In most cases of the thoracolumbar infarction, the swollen cord shows peripheral enhancement of the central gray matter. The concomitant enhancement of the cauda equina was reported first by Friedman and Flanders in 1992 (Fig. 17.8). This phenomenon is a characteristic finding in the course of spinal cord ischemia which might involve the cord itself and the ventral cauda equina as well, which is composed of motor fibre bundles (Amano et al. 1998). It indicates disruption of the blood-cord barrier as well as reactive hyperemia (Friedman and Flanders 1992 Amano et al. 1998). The differential diagnosis of contrast enhancement of the cauda equina includes transverse myelitis, bacterial or viral meningitis, and spinal metastasis. 

In few studies, DWI is reported to detect spinal cord ischemia in the acute phase (Gass et al. 2000 Bammer et al. 2000 Stepper and L5vblad 2001). Kuker and coworkers (2004) recently reported the time course of diffusion abnormalityin three patients with acute spinal cord ischemia. They found diffusion abnormality earliest after 8 h. At this time there was only a faint hyperintensity visible in the central part of the conus medullaris. Diffusion abnormality did not last for longer than 1 week. Further stud-... 

Selective spinal DSA has a better spatial resolution and plays a main role in the exclusion of spinal vascular malformations. In selected cases affection of the radicular artery and occlusion of the anterior spinal artery system can be demonstrated as well as collateral supply even in the later course of the ischemia (Mull et al. 2002). Thus, spinal DSA helps to identify pathologic vascular conditions in spinal cord ischemia. The main indication remains to exclude a spinal vascular malformation. Angiographic information about the acute phase of spinal cord ischemia is not yet available. 

To identify the location of cord-supplying segmental arteries before aortic surgery can help to reduce the risk of spinal cord ischemia. Monitoring of somatosensory-evoked responses contrib-... 

In summary, important advances have been made in our understanding of the underlying pathogenetic mechanism in spinal cord ischemia. This condition remains a diagnostic and therapeutic challenge, but improved diagnosis may result in better treatment in the future. 

Burguet JL, Dietemann JL, Wackenheim A, Kehr P, Buchheit F (1985) Sacral meningeal arteriovenous fistula fed by branches of the hypogastric arteries and drained through medullary veins. Neuroradiology 27 232-237 Caplan L (2003) Spinal Cord Ischemia. In Neurological Disorders Course and Treatment, Second Edition, Elsevier Science 393-401. 

Mull M, Thron A (2004) Imaging of Vscular Diseases of the Spinal Cord. Rivista di Neuroradiologia 17 (3) 351—359 Mull M, Thron A, Petersen D, Stoeter P (1992) Acute infarction of the spinal cord clinical and neuroradiological findings in 20 patients. Neuroradiology 34 43 Mull M, Kosinski C, and Thron A (2002) Acute spinal cord ischemia - contribution of spinal angiography. J. Neuroradiol. 29 1-86... 

More direct evidence for a role of lipid peroxidation in the development of post-traumatic spinal-cord ischemia is obtained from studies that have examined the effect of intensive antioxidant dosing on the progressive decline in SCBF after contusion injury in cats [28,29]. In one experiment, cats were pretreated daily with high oral doses of D-a-tocopherol (1000IU) and selenium (50 pg) for 5 days prior to spinal contusion injury. In untreated cats, moderately severe spinal contusion injury resulted in a progressive decrease in SCBF from near-normal levels immediately after injury to 53.5% below the pre-injury level 4 hours later. 

Hall, E.D., Wolf, D.L. and Braughler, J.M. (1984) Effects of a single large dose of methylprednisolone sodium succinate on experimental post-traumatic spinal cord ischemia dose-response and time-action analysis, J. Neurosurg. 61, 124-130. 

Sato M, et al. Cyclosporin A reduces delayed motor neuron death after spinal cord ischemia in rabbits. Ann. Thorac. Surg. 2003 75 1294-1299. 

Thrombosis in elderly patients with an increased risk of thrombosis, such as those with hypertension or previous episodes of infarction, has been described (44). A few cases of thrombosis subsequent to intravenous immunoglobulin have been reported, including myocardial infarction in five patients, stroke in four cases, and spinal cord ischemia in one (45). It has been postulated that these events are induced by platelet activation and increased plasma viscosity (12). 

Lapchak, P. A., Chapman, D. F., Nunez, S. Y. and Zivin, J. A. Dehydroepiandrosterone sulfate is neuroprotective in a reversible spinal cord ischemia model Possible involvement of GABAa receptors. Stroke 31 (2000) 1953-1956. 

HaU ED (1988) Effects of the 21-aminosteroid U74006F on posttraumatic spinal cord ischemia in cats. J Neurosurg 68 462-465... 

Picone AL, Green RM, Ricotta JR, May AG, DeWeese JA (1986) Spinal cord ischemia following operations on the abdominal aorta. Vase Surg 3 94-103... 

The most devastating complication is spinal cord ischemia, that has been reported to occur in 1.4%-6.5% of patients treated with bronchial artery embolization [9,30,39]. The occurrence of this complication can be reduced by using a superselective embolization technique, performing regular control angiograms before and after administration of embolic agents as has been described above. 

Shackelford, D. A., Yeh, R.,andZivin,J. A. (1993) Inactivation and subcellular redistribution of Ca /calmodulin-dependent protein kinase II following spinal cord ischemia. /. Neuro-chem. 61, 738-747. 

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