An Overview of Spinal Cord Strokes

If you or a loved one have been told that you have had a spinal cord infarct, you most likely do not know what to expect. Most people have never heard of a spinal cord infarct before. While the majority of strokes affect the brain, these are strokes that affect the spinal cord.

Wheelchair in hospital corridor
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Overview

Spinal infarcts account for only about 1% of all strokes. The triggers and effects of spinal infarcts vary. What they all have in common is spinal cord damage caused by lack of blood flow. The effects depend on the location of the infarct within the spinal cord, how severe the injury is, and also on whether the spinal infarct is treated quickly.

The spinal cord, like every part of the body, needs to receive blood in order to get oxygen and nutrients. The oxygen and nutrients allow the spine to function and survive. Blood vessels called spinal arteries deliver oxygen-rich, nutrient-rich blood to the spinal cord. If blood flow through one or more of the spinal arteries is interrupted, then the region of the spinal cord that normally receives blood through that vessel suffers.

The Spinal Cord

Your spinal cord is enclosed within your spine (backbone). Your spinal cord is a relay station that connects the messages between the different parts of your body and your brain.

When you want to move one of your muscles, your brain sends messages through your spinal cord and then through the nerves that control that particular muscle. Similarly, when you feel a sensation in a part of your body, the nerves on your skin send messages up through your spinal cord to your brain so that you can become aware of your body's sensations.

Any damage from a spinal infarct can affect the spinal cord’s ability to function as an effective relay station, interfering with your sensation, your muscle movements, or both.

Consequences of a Spinal Cord Infarct

If you have had a spinal cord infarct, you may experience permanent neurological effects as a result. The particular effects depend on the location of the spinal infarct and how severe it is.

The location of a spinal infarct is described according to the height and depth of the spinal cord. One component of spinal cord location is based on the ‘up and down’ level within the spinal cord, defined as the spinal cord level. The other component of spinal cord location depends on how far ‘in or out’ of the spinal cord the injury is, described as the spinal tract.

Spinal Cord Level

The higher a spinal infarct is, the worse the damage. This means that when a spinal infarct occurs near the neck, at the level of the cervical spinal cord, the resulting problem will affect bodily functions at and below the neck.

When a spinal infarct occurs in the middle and lower portions of the back, at the regions of the thoracic and lumbar spinal cord, then bodily functions in the legs and lower parts of the body will be affected, not bodily functions in the arms and upper parts of the body.

Spinal Tract

The spinal cord is shaped somewhat like a solid circular tube, although it is not a perfect circle, and it is not perfectly solid. The parts of the spinal cord nearer to the back of the body control functions such as sensation, and the parts of the spinal cord nearer the interior of the body control functions such as movement.

Also, the left side of the spinal cord controls only half of the body’s sensation and movement, while the right side of the spinal cord controls half of the body’s sensation and movement.

A section within the spinal cord with a particular ‘job’ is often referred to as a tract. A spinal infarct has different effects depending on which tract was injured and on whether the infarct affected the right side of the spinal cord, the left side, or both.

Some spinal infarcts cause a problem with sensation, some cause a problem with muscle strength, some affect the right side, and some affect the left side. Most spinal infarcts cause a combination of these problems, because a spinal infarct normally damages more than one spinal tract at a time.

Causes

There are a number of causes of spinal cord infarct. This problem is not typically caused by heart disease and atherosclerosis, which are the usual causes of an infarct in the brain.

Spinal cord infarct may result from bleeding or blood clots in one of the blood vessels of the abdomen, particularly the abdominal aorta. Severe trauma to the body can compromise the blood flow to the spinal cord, causing spinal cord infarct.

Other causes of spinal cord infarct include infections, cancer, blood diseases, and autoimmune or inflammatory disease. If you or a loved one have had a spinal infarct, then your doctors will work quickly to find out the cause and to treat it as soon as possible.

Treatment of Spinal Cord Infarct

Treatment may include blood thinners if a blood clot is the cause of the spinal infarct. Some newer treatment options for spinal cord infarct include powerful blood thinners, such as tissue plasminogen activator (TPA), but there are only a few scientific studies describing the effectiveness of TPA in the setting of a spinal infarct.

If doctors decide to treat a patient with emergency TPA for a spinal infarct, this is a decision that must be made very quickly to maximize effectiveness and to minimize dangerous complications, such as bleeding.

Sometimes, bleeding is the cause of a spinal infarct. In such situations, it is usually the result of a bleeding abdominal aorta, and surgery may be indicated, sometimes urgently.

Prognosis

The bad news is that a spinal cord infarct often results in very bad outcomes. There are a few reasons for this.

One of the more serious causes of emergency spinal cord infarct, abdominal aneurysm rupture, is a dangerous and life-threatening condition that causes rapid and severe bleeding and blood loss. Several of the causes of spinal cord infarct are related to severe trauma and other major illnesses, which makes battling spinal cord infarct along with the other disease that caused the spinal cord infarct a huge uphill challenge.

The other reason that spinal cord infarcts often result in bad outcomes is that the spinal cord damage is particularly hard to recover from. It is rare for medical intervention to bring back any function lost from a spinal infarct. Most of the time, medical intervention for spinal cord damage is a way to prevent further damage, not to restore or repair spinal cord damage.

Ongoing research to discover treatments for incurable diseases like spinal cord damage include research on neuroplasticity and stem cell therapy, which involve repairing and regenerating damaged nerves.

Coping

Life after spinal cord infarct may require serious lifestyle adjustments. If you or your loved one do not have a major disability as a result of the spinal cord infarct, then the key component of recovery involves medical management of the cause of spinal infarct.

If you have a major disability, then dedicated physical therapy and occupational therapy can help you maximize your abilities and learn how to keep your body as healthy and safe as possible. The United Spinal Association and the Christopher and Dana Reeve Foundation are a few of the organizations dedicated to providing resources and help for people living with spinal cord injury.

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  1. Caton MT, Huff JS. Spinal Cord Ischemia. [Updated 2020 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.

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