Anterior spinal artery syndrome

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Anterior spinal artery syndrome.
Classification and external resources
Cord-en.png
Anterior cord syndrome is central diagram
ICD-10 I65.8
ICD-9 433.8 806.02, 806.07, 806.12, 806.17, 806.22, 806.27, 806.32, 806.37
DiseasesDB 33437
eMedicine neuro/348
MeSH D020759

Anterior spinal artery syndrome is a medical condition where the blood supply to the anterior portion of the spinal cord is interrupted and "is the most common form of spinal cord infarction".[1] The anterior portion of the spinal cord is supplied by the anterior spinal artery. It begins at the foramen magnum where branches of the two vertebral arteries exit, merge and descend along the anterior spinal cord. As the anterior spinal artery proceeds inferiorly, it receives branches originating mostly from the aorta.[1] It is characterized by loss of motor function below the level of injury, loss of sensations carried by the anterior columns of the spinal cord (pain and temperature), and preservation of sensations carried by the posterior columns (fine touch and proprioception).

A type of incomplete spinal cord injury, anterior spinal syndrome is produced by injury of the motor and sensory paths of the anterior part of the spinal cord. Patients cannot feel coarse sensations such as pain and temperature, which are carried through the anterolateral pathways. However, proprioceptive sense and sensation of fine touch are preserved.

Ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral two-thirds of the spinal cord and Medulla.

Signs and symptoms[edit]

  • Complete motor paralysis below the level of the lesion due to interruption of the corticospinal tract
  • Loss of pain and temperature sensation at and below the level of the lesion due to interruption of the spinothalamic tract[2]
  • Retained proprioception and vibratory sensation due to intact dorsal columns[2][3]
  • Autonomic dysfunction may be present and can manifest as hypotension (either orthostatic or frank hypotension), sexual dysfunction, and/or bowel and bladder dysfunction[4][5]
  • Areflexia, flaccid anal sphincter, urinary retention and intestinal obstruction may also be present in individuals with anterior cord syndrome.[1]

Symptoms usually occur very quickly and are often experienced within one hour of the initial damage. MRI can detect the magnitude and location of the damage 10–15 hours after the initiation of symptoms. Diffusion-weighted imaging may be used as it is able to identify the damage within a few minutes of symptomatic onset.[1]

Clinical features include quadriparesis (depending on the level of the injury) and impaired pain and temperature sensation. Complete motor paralysis below the level of the lesion due to interruption of the cortico spinal tract, and loss of pain and temperature sensation at and below the level of the lesion. Proprioception and vibratory sensation is preserved, as it is in the dorsal side of the spinal cord.

Causes[edit]

Due to the branches of the aorta that supply the anterior spinal artery, the most common causes are insufficiencies within the aorta. These include aortic aneurysms, dissections, direct trauma to the aorta, surgeries and atherosclerosis. Acute disc herniation, cervical spondylosis, kyphoscoliosis, damage to the spinal column and neoplasia all could result in ischemia from anterior spinal artery occlusion leading to anterior cord syndrome. Other causes include vasculitis, polycythemia, sickle cell disease, decompression sickness, cocaine use and collagen and elastin disorders.[1]

Treatment and prognosis[edit]

Treatment is determined based on the primary cause of anterior cord syndrome. When the diagnosis of anterior cord syndrome is determined, the prognosis is unfortunate. The mortality rate is approximately 20%, with 50% of individuals living with anterior cord syndrome having very little or no changes in symptoms.[1]

Eponym[edit]

It is also known as "Beck's syndrome".[6][7]

References[edit]

  1. ^ a b c d e f Schneider, Gregory S. (2010). "Anterior spinal cord syndrome after initiation of treatment with atenolol". The Journal of Emergency Medicine 38 (5): e49–e52. doi:10.1016/j.jemermed.2007.08.061. 
  2. ^ a b Foo, D; Rossier, AB (Feb 1983). "Anterior spinal artery syndrome and its natural history.". Paraplegia 21 (1): 1–10. PMID 6835686. 
  3. ^ Wheele's Orthopedics
  4. ^ Cheshire, WP; Santos, CC; Massey, EW; Howard JF, Jr (Aug 1996). "Spinal cord infarction: etiology and outcome.". Neurology 47 (2): 321–30. PMID 8757000. 
  5. ^ Cheung, AT; Weiss, SJ; McGarvey, ML; Stecker, MM; Hogan, MS; Escherich, A; Bavaria, JE (Aug 2002). "Interventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction.". The Annals of thoracic surgery 74 (2): 413–9; discussion 420–1. PMID 12173822. 
  6. ^ synd/755 at Who Named It?
  7. ^ Beck, Karl (1951–1952). "Das Syndrom des Verschlusses der vorderen Spinalarterie". Deutsche Zeitschrift für Nervenheilkunde 167 (3): 164–186. doi:10.1007/BF00242756.