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Spinal Cord Vascular Disease

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Neurological Aspects of Spinal Cord Injury

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Abstract

This chapter describes the two main disease entities affecting the spinal cord vasculature, spinal cord ischemia, and spinal vascular malformation.

Spinal cord ischemia differs significantly from cerebral ischemia patients in terms of age, clinical presentation and course, risk factors, and underlying pathology. Clinical severity depends on the lesion extent and the lesion level. Recovery is most often incomplete and about 50 % of patients remain wheelchair bound. The etiology of spinal cord ischemia can be divided into three entities, all of which have different diagnostic algorithms, different preventive, acute/rehabilitative strategies and different outcomes: (a) spontaneous, (b) complication of an underlying acute disease, and (c) complication of aortic diagnostic/therapeutic procedures. Spontaneous spinal cord ischemia is often attributed to the typical cerebral ischemia risk factors. However, diagnostic workup needs to be broader including underlying inflammatory causes (infectious, parainfectious, autoimmune). At the same time, diagnostic imaging in the acute phase is more challenging compared to cerebral ischemia, which hampers efforts for acute therapeutic interventions such as thrombolysis. As further treatment option, in particular after aortic surgery, lowering of the intraspinal pressure by lumbar drainage to increase intraspinal perfusion pressure can be considered.

In most instances, spinal vascular malformations consisting of spinal dural arteriovenous fistulas, arteriovenous malformations, and cavernous angiomas cause a more slowly progressive disease manifestation as opposed to the sudden onset in spinal cord ischemia. The underlying pathophysiological mechanism is based on arterial blood shunted into perimedullar veins, which causes venous congestion in the spinal cord parenchyma. Depending on the type of malformation, effective neurosurgical and interventional treatment options are available. The prognosis heavily depends on an early diagnosis and treatment, which may allow to at least partially reverse neurological dysfunction.

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Authors and Affiliations

  1. Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstr. 200a, Heidelberg, Germany

    Norbert Weidner

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  1. Norbert Weidner
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Correspondence to Norbert Weidner .

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Editors and Affiliations

  1. Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany

    Norbert Weidner

  2. Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany

    Rüdiger Rupp

  3. Methodist Rehabilitation Center, University of Mississippi Medical Center, Veterans Administration Medical Center, Jackson, Mississippi, USA

    Keith E. Tansey

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Weidner, N. (2017). Spinal Cord Vascular Disease. In: Weidner, N., Rupp, R., Tansey, K. (eds) Neurological Aspects of Spinal Cord Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-46293-6_5

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  • DOI: https://doi.org/10.1007/978-3-319-46293-6_5

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