Traumatic spinal cord injury: a neuropathological study on the longitudinal spreading of the lesions.
Eight patients died after traumatic spinal cord injuries. At autopsy, neuropathological examination revealed longitudinal spreading of cord lesions in two of these patients. One developed progressive paralysis 43 h after fracture of the fifth cervical (C5) vertebra and died 38 days after injury. Necrotic lesions extended upward to the medulla oblongata and downward to the C7 cord segment. Pencil-shaped necrosis (C7-T4) and marginal spongiosis (C7-T2) were also found. A second patient died 5 months after C5 subluxation with tetraplegia. His spinal cord was severely compressed at C4/5 and pencil-shaped necrosis, which had become partially cystic, extended upward to C3 and downward to T1; marginal spongiosis was also found in C4-C5. In both cases, complete necrosis without cell reaction was found in several cord segments, including the initially impacted segment. These findings suggest that intra- and extramedullary circulatory impairment occurred not only at the initial impact level, but also in the adjacent levels. Increased intramedullary pressure, resulting from this circulatory disturbance, in combination with a narrowed spinal canal, may induce the upward and downward spreading of the lesion.
Ito
T
T
Department of Pathology, Niigata University, Japan.
Oyanagi
K
K
Wakabayashi
K
K
Ikuta
F
F
D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009474:Neurons / Q000473:pathology*; D013116:Spinal Cord / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000473:pathology*