Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

Vascular Disease of Spinal Cord 1519

VASCULAR DISEASE OF SPINAL CORD

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Sudden onset of back or limb pain & of neurologic deficit in limbs or

sphincter disturbance

■Flaccid, areflexic paraparesis leading to spastic paraparesis w/

hyperreflexia & extensor plantar responses

■Sensory deficit in legs; typically is dissociated loss (impaired pinprick

& temperature sensation, preserved postural & vibration sense) w/

cord infarction from occlusion of anterior spinal artery; may be more

global sensory loss w/ hematomas compressing cord

■Brown-Sequard syndrome may occur w/ intrinsic or extrinsic hema-

tomas or occluded branch of anterior spinal artery

tests

■Blood studies: CBC & differential count, ESR, PT & PTT, FBS, LFT,

RPR, cardiac enzymes, cholesterol & lipids, antiphospholipid anti-

bodies

■Imaging studies typically normal initially w/ cord infarction; show

intramedullary, subdural or epidural hematomas

differential diagnosis

■Imaging studies distinguish btwn infarct & hematomas; pts may have

history of bleeding disorder, anticoagulant use or recent trauma or

lumbar puncture

■AVM of spinal cord causes myeloradiculopathy, cord infarction or

spinal subarachnoid hemorrhage; myelogram is required if MRI is

unrevealing

management

■Urgent decompression for subdural or epidural hematomas

■Symptomatic measures, including catheterization for urinary reten-

tion

specific therapy

■Subdural or epidural hematoma requires urgent evacuation.

■Treatment for cord infarction is purely symptomatic.

■AVM can usually be treated by embolization or surgery after angio-

graphic delineation.