title: Diagnostic and Prognostic Relevance of Magnetic Resonance Imaging and Electrophysiological Findings in Acute Spinal Ischemia.
abstract: OBJECTIVE
  Our purpose was to classify the rare entity of spontaneous spinal ischemia with clinical, magnetic resonance-tomographic, and electrophysiological parameters to determine criteria for outcome prediction.
  
  
  METHODS
  We analyzed the stroke registry database of the University Hospital Mannheim, Germany, from 2004 to 2010 for patients with a diagnosis of vascular spinal cord ischemia.
  
  
  RESULTS
  Ten patients were identified (mean age 65 years [range 50-83], 5 women). In 5 patients an etiology was found. Spinal diffusion-weighted magnetic resonance imaging revealed acute ischemia in 7 patients at initial imaging and this diagnosis was confirmed during the first week in the remaining 3 patients. Electrophysiological studies showed abnormal motor evoked potentials (MEPs) in 8 patients and abnormal somatosensory evoked potentials (SSEPs) in 7 patients. After rehabilitation, 5 patients had regained walking ability, whereas 5 patients stayed wheelchair bound. All patients with unfavorable outcome (American Spinal Injury Association (ASIA) Impairment score [AIS] score of ≤C) showed severe pyramidal tract lesions in MEPs during the first week. All patients with normal MEPs had an excellent outcome (AIS of E, P < .05).
  
  
  CONCLUSIONS
  Diffusion-weighted imaging (DWI) is a useful tool to confirm acute spinal ischemia suspected in patients within the first days after symptom onset. Poor outcome was associated with severe electrophysiological abnormalities in MEPs and SSEPs. Normal MEPs were significantly predictive of an excellent prognosis. A multimodal diagnostic approach combining DWI and electrophysiological evaluation facilitates the prediction of the individual clinical outcome.
authors.affiliation: Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany. Electronic address: dimartemis@gmail.com.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Artemis
authors.affiliation: Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Wolf
authors.affiliation: Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Blahak
authors.affiliation: Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Szabo
authors.affiliation: Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hennerici
authors.affiliation: Department of Neurology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Fatar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020760:Spinal Cord Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: Spinal infarct; diffusion-weighted imaging; magnetic resonance imaging; motor evoked potentials; rehabilitation; somatosensory evoked potentials