1 / 23

Imaging of Spinal Stroke

Imaging of Spinal Stroke. Institute of Neuroradiology, University of Zurich, Switzerland. Spinal cord infarction: frequency. not established, large clinical investigations are lacking ~1% of all strokes, annual incidence of 12 in 100,000 occurrence rate at death: 0.23% (9/3784) autopsies

ginata
Download Presentation

Imaging of Spinal Stroke

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Imaging of Spinal Stroke Institute of Neuroradiology, University of Zurich, Switzerland

  2. Spinal cord infarction: frequency • not established, large clinical investigations are lacking • ~1% of all strokes,annual incidence of 12 in 100,000 • occurrence rate at death: 0.23% (9/3784) autopsies • small arterial vessels with low flow rates • extensive collateral network between the main medullary arteries at the spinal cord surface

  3. T3 T8 T8 Lazorthes, G. et al. Rev Neurol 1966;115:1055-1068. Arteries supplying the spinal cord Novy, J. et al. Arch Neurol 2006;63:1113-1120.

  4. Spinal cord infarction: clinical symptoms • acute onset, severe back pain • bilateral weakness, paresthesias and sensory loss • loss of sphincter control evident within a few hours • confounding diagnoses (acute transverse myelopathy, viral myelitis, Guillain-Barré, mass lesions), develop over 24-72 h with slower evolution, rarely painful • epidural/subdural hematomas need exclusion by MRI • symptoms and degree of deficits depend on the affected level and size of the vascular territories

  5. Spinal cord infarction: etiology Classification according to location of vascular pathology • intrinsic cord vessels: arteritis (SLE, granulomatous), emboli of atheroma, disc compression • ASA occlusion: arteritis, trauma, spondylosis, adhesive arachnoiditis, spinal DSA, anesthesia • aortic disease: dissecting aneurysm, surgery, aortic thrombosis, atherosclerotic embolization • uncommon causes: decompression sickness, circulatory failure (cardiac arrest, hypotension) • no identifiable cause:50-75% of cases

  6. Spinal cord infarction: pathogenesis a) mechanical triggering factor: - anterior, posterior - unilateral or bilateral coincides with the level of the involved radicular artery b) hypoperfusion factor: - central and transverse involve several levels in the thoracolumbar region Novy, J. et al. Arch Neurol 2006;63:1113-1120.

  7. Imaging of spinal cord infarction: MRI • T2-w imaging not sensitive in the first hours after symptoms onset (abnormal signal in 45%-67%) • “snake-eyes” on axial T2-w images indicate involvement of the ventral gray matter • contrast enhancement in the subacute stage • hemorrhagic transformation seen as hyperintense signal on the T1-weighted images.

  8. Vulnerability of spinal cord to anoxia • The gray matter is predominantly affected due to its high vulnerability to anoxia • Motorneurons lose electrophysiological reflex responses 1.5 times faster as interneurons and 3 times faster as dorsal column neurons • terminal ischemia (failure of conduction) occurs after 20 minutes of asphyxia • abrupt anoxia shortens the survival time of all structures Gelfan S, Tarlov IM. J Neurophysiol 1955;18:170-188.

  9. Th4 70 y, history aortic dissection, status after grafting, hypertension, coronary artery disease presents with acute paraplegia.

  10. DW-MRI of the spinal cord Challenges: • fine structure and elasticity of the SC • requirement for high in-plane resolution • Artifacts related to motion • CSF pulsations • respiratory motion • swallowing • Spatially rapid changes in susceptibility

  11. Imaging of spinal cord infarction: DW-MRI • demonstration of intracelullar, cytotoxic edema • diffusion abnormality reported 4-30 h following onset, always in the presence of T2-w signal abnormality • decrease (75%) of the calculated ADC values • in follow-up performed 5-20 d following infarction, early normalization of ADC with persistent T2-w abnormality

  12. 26-year-old man left-sided neck pain, acute onset lower limb weakness and difficulty voiding.

  13. 2 w follow-up 2 m follow-up Zhang J., et al. J Spinal Disord Tech. 2005; 18:277-282

  14. Zhang J, et a. JMRI 2007;26:848-854

  15. Spinal cord infarction • Prognosis and outcome • substantial motor, sensory, bladder and bowel dysfunction • short-term mortality rate 20-25% • vascular, infectious and other medical complications • long term prognosis is determined by the degree of cord sparing (unilateral infarcts have better prognosis) • early diagnosis may contribute to improved patient management

More Related