The anterior spinal cord syndrome (also known as "anterior spinal cord syndrome") is a medical condition in which the anterior spinal artery, the primary blood supply to the anterior part of the spinal cord, is impaired, causing ischemia or spinal cord infarction in the anterior two thirds of the spinal cord and medulla oblongata. It is characterized by a loss of motor functioning below the level of injury, loss of sensation brought by the anterior column of the spinal cord (pain and temperature), and the preservation of sensations brought by the posterior column (subtle touch, vibration and proprioception). The anterior spine artery syndrome is the most common form of spinal cord infarction.
Video Anterior spinal artery syndrome
Signs and symptoms
- Complete motor lysis under the level of the lesion due to interference with the corticospinal tract
- Loss of pain and temperature sensation at and below the level of the lesion due to disturbance of the spinothalamic tract
- Retrio proprioception and vibration sensation due to intact dorsal columns
- Autonomic dysfunction can occur and may manifest as hypotension (orthostatic or frank hypotension), sexual dysfunction, and/or bowel and bladder dysfunction
- Areflexia, weak internal and external anal sphincters, urinary retention and intestinal obstruction may also be present in individuals with cord syndrome.
Symptoms usually occur very quickly and are often experienced within an hour of initial damage. MRI can detect magnitude and location of damage 10-15 hours after initiation of symptoms. Imaging with diffuse weights can be used because it is able to identify damage within minutes of symptom onset.
Clinical features include paraparesis or quadriparesis (depending on the degree of injury) and pain and temperature sensation. Complete motor paralysis below the lesion level due to corticospinal tract disorders, and loss of pain and temperature sensation at and below the level of the lesion. Proprioception and vibration sensations are maintained, such as on the dorsal side of the spinal cord.
Maps Anterior spinal artery syndrome
Cause
Because of the aortic branches that supply the anterior spinal artery, the most common cause is insufficiency in the aorta. These include aortic aneurysms, dissection, direct trauma to the aorta, surgery, and atherosclerosis. Acute disc herniation, cervical spondylosis, kyphoscoliosis, spinal damage and neoplasia can all lead to ischemia from the occlusion of the anterior spinal artery leading to anterior cord syndrome. Other causes include vasculitis, polycythemia, sickle cell disease, decompression disease, and collagen and elastin disorders. Any embolus or thrombus in the largest feeding vessel known as the Adamkiewicz artery, can cause anterior spine syndrome. This is the most feared complication of bronchial artery embolization, although rare in massive haemoptysis.
Anatomy
The anterior part of the spinal cord is supplied by the anterior spinal artery. It begins in the foramen magnum in which branches of two vertebral arteries exit, join, and descend along the anterior spinal cord. When the anterior spinal artery proceeds inferiorly, it receives branches that are mostly derived from the aorta. The largest aortic branch is the Adamkiewicz artery.
Diagnosis
Treatment and prognosis
Treatment is determined based on the main cause of cord syndrome. When the diagnosis of cord syndrome is determined, the prognosis is unfortunate. The mortality rate is about 20%, with 50% of people living with cord syndrome having little or no change in symptoms.
Eponyms
It is also known as "Beck's syndrome".
See also
- spinal cord injury
References
External links
Source of the article : Wikipedia
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