Long-term outcome of acute spinal cord ischemia syndrome.
OBJECTIVE
Current knowledge of long-term outcome in patients with acute spinal cord ischemia syndrome (ASCIS) is based on few studies with small sample sizes and <2 years' follow-up. Therefore, we analyzed clinical features and outcome of all types of ASCIS to define predictors of recovery.


METHODS
From January 1990 through October 2002, 57 patients with ASCIS were admitted to our center. Follow-up data were available for 54. Neurological syndrome and initial degree of impairment were defined according to American Spinal Injury Association (ASIA)/International Medical Society of Paraplegia criteria. Functional outcome was assessed by walking ability and bladder control.


RESULTS
Mean age was 59.4 years; 29 were women; and mean follow-up was 4.5 years. The origin was atherosclerosis in 33.3%, aortic pathology in 15.8%, degenerative spine disease in 15.8%, cardiac embolism in 3.5%, systemic hypotension in 1.8%, epidural anesthesia in 1.8%, and cryptogenic in 28%. The initial motor deficit was severe in 30% (ASIA grades A and B), moderate in 28% (ASIA C), and mild in 42% (ASIA D). At follow-up, 41% had regained full walking ability, 30% were able to walk with aids, 20% were wheelchair bound, and 9% had died. Severe initial impairment (ASIA A and B) and female sex were independent predictors of unfavorable outcome (P=0.012 and P=0.043).


CONCLUSIONS
Considering a broad spectrum of clinical presentations and origins, the outcome in our study was more favorable than in previous studies reporting on ASCIS subgroups with more severe initial deficits.
Nedeltchev
Krassen
K
Department of Neurology, University Hospital of Bern, Inselspital, Bern, Switzerland.
Loher
Thomas J
TJ
Stepper
Frank
F
Arnold
Marcel
M
Schroth
Gerhard
G
Mattle
Heinrich P
HP
Sturzenegger
Matthias
M
D000208:Acute Disease; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020760:Spinal Cord Ischemia / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D013557:Switzerland; D013577:Syndrome; D013995:Time; D001750:Urinary Bladder, Neurogenic / Q000209:etiology