Spinal cord ischemia: aetiology, clinical syndromes and imaging features.
BACKGROUND
The purpose of this study was to analyse MR imaging features and lesion patterns as defined by compromised vascular territories, correlating them to different clinical syndromes and aetiological aspects.


METHODS
In a 19.8-year period, clinical records and magnetic resonance imaging (MRI) features of 55 consecutive patients suffering from spinal cord ischemia were evaluated.


RESULTS
Aetiologies of infarcts were arteriosclerosis of the aorta and vertebral arteries (23.6%), aortic surgery or interventional aneurysm repair (11%) and aortic and vertebral artery dissection (11%), and in 23.6%, aetiology remained unclear. Infarcts occurred in 38.2% at the cervical and thoracic level, respectively, and 49% of patients suffered from centromedullar syndrome caused by anterior spinal artery ischemia. MRI disclosed hyperintense pencil-like lesion pattern on T2WI in 98.2%, cord swelling in 40%, enhancement on post-contrast T1WI in 42.9% and always hyperintense signal on diffusion-weighted imaging (DWI) when acquired.


CONCLUSIONS
The most common clinical feature in spinal cord ischemia is a centromedullar syndrome, and in contrast to anterior spinal artery ischemia, infarcts in the posterior spinal artery territory are rare. The exclusively cervical location of the spinal sulcal artery syndrome seems to be a likely consequence of anterior spinal artery duplication which is observed preferentially here.
Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital of the Goethe - University, Frankfurt / Main, Seckbacher Landstraße 65, D 60389, Frankfurt / Main, Germany, stefan.weidauer@sankt-katharinen-ffm.de.
Stefan
S
Weidauer
Michael
M
Nichtweiß
Elke
E
Hattingen
Joachim
J
Berkefeld
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000150:complications* / Q000473:pathology; D050197:Atherosclerosis / Q000150:complications* / Q000473:pathology; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000473:pathology; D020760:Spinal Cord Ischemia / Q000209:etiology* / Q000473:pathology*; D013577:Syndrome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult