Spinal Cord Infarction

Nutrition marrow is provided by three arteries with vertical route, sending branches inside the marrow. The three main arteries are represented by an anterior spinal artery and two posterior spinal arteries. These arteries communicate with each other by anastomosis perimedulare. For these anastomotic branches perforating arteries arise perimedulare which go into the marrow. The three main arteries have their origin in the vertebral arteries.Branches of previous spinal artery blood into 2 / 3 previous spinal and posterior spinal arteries pump blood into the posterior cords.Lateral regions are irrigated by perforating branches from anastomoses of previous spinal artery posterior spinal arteries. Spinal arterial trunks arise from the union of upward and downward longitudinal anastomosis, segmental arteries that send them to different floors of the spinal marrow. These anastomoses provide sufficient blood flow. Raman, however, some border regions, the region T3-T4 and T11-L2, in which blood flow is reduced.
Spinal cord ischemia can occur at any level. Anterior spinal artery may be discontinuous at some cases, making the vasculature by side branches to gain a more important issue. In the event of systemic hypotension, the most targeted areas are those with spinal relatively poor circulation, such as the T3-T4 or T11-L2 and the border areas between the territories of the anterior and posterior spinal arteries.
Determinants Items that are precipitated medullary infarction aortic atherosclerosis, hypotension from any cause, dissecting aortic aneurysm is associated with chest pain before or after the established and reduce pulsations in the legs. Other predisposing factors are collagen vasculitis, heart emboli, surgical clipping of an aortic aneurysm. Medullary infarctions can occur in case of a spinal injury, sustained after an exercise or during pregnancy.
Clinical Symptoms are determined by the level at which there was a heart, and vascular anatomy of the individual. Infarction occurs in the irrigation area of ​​previous spinal artery is clinically manifested by paraplegia or quadriplegia, dissociated loss of pain and thermal sensitivity and sphincter disorders. Method of onset varies and can be sudden or gradual, in a few hours. The infarct area is a pain living the midline. If a half of a previous myocardial meets marrow or monoplegia hemiplegia, accompanied by painful loss and thermal cross sensitivity.
Neurological examination can highlight even the abolition of tendon reflexes at the onset of stroke, and occurs over time hyperreflexia and spasticity, as a result of failure of cortical control. If a heart attack in the territory of the posterior spinal arteries irrigation, loss of function is seen posterior cords, resulting in loss of vibratory sensation and artrokinetice.
Differential diagnosis is mainly with epidural spinal cord compression, in which case the pain is a chronic, posterior cord is damaged, and the marrow is imprecisely defined. A special situation is found when epidural tumors invade vascular structures, thus endangering traffic. Laboratory diagnosis is made in the first emergency investigation is MRI (magnetic resonance imaging).MRI offers a diagnosis of exclusion, meaning that the heart is normal in bone marrow, but shows changes in the case of cord compression, hematomielia (bleeding bone marrow), or infectious myelitis transverse myelitis. If the MRI does not provide relevant information, lumbar puncture is performed to study the cerebrospinal fluid. Also, determine CBC, ESR, VDRL reaction and carried out an ECG for changes that could precipitate cardiac medullary infarction.
Treatment The predisposing cause-oriented treatment. If the heart is due to an embolism, you can try a treatment with streptokinase or urokinaza.