Anterior spinal artery syndrome

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Anterior spinal artery syndrome (also known as "anterior spinal cord syndrome") is syndrome caused by ischemia of the anterior spinal artery, resulting in loss of function of the anterior two-thirds of the spinal cord. The region affected includes the descending corticospinal tract, ascending spinothalamic tract, and autonomic fibers. It is characterized by a corresponding loss of motor function, loss of pain and temperature sensation, and hypotension.

Contents

Anterior spinal artery syndrome is the most common form of spinal cord infarction. [1] The anterior spinal cord is at increased risk for infarction because it is supplied by the single anterior spinal artery, which has few collateral unlike the posterior spinal cord which is supplied by two posterior spinal arteries.

Signs and symptoms

Symptoms usually occur very quickly and are often experienced within one hour of the initial damage. MRI can detect the magnitude and location of the damage 10–15 hours after the initiation of symptoms. Diffusion-weighted imaging may be used as it is able to identify the damage within a few minutes of symptomatic onset. [1]

Clinical features include paraparesis or quadriparesis (depending on the level of the injury) and impaired pain and temperature sensation. Complete motor paralysis below the level of the lesion due to interruption of the corticospinal tract, and loss of pain and temperature sensation at and below the level of the lesion. Proprioception and vibratory sensation is preserved, as it is in the dorsal side of the spinal cord.[ citation needed ]

Causes

Due to the branches of the aorta that supply the anterior spinal artery, the most common causes are insufficiencies within the aorta. These include aortic aneurysms, dissections, direct trauma to the aorta, surgeries, and atherosclerosis. Acute disc herniation, cervical spondylosis, kyphoscoliosis, damage to the spinal column and neoplasia all could result in ischemia from anterior spinal artery occlusion leading to anterior cord syndrome. Other causes include vasculitis, polycythemia, sickle cell disease, decompression sickness, and collagen and elastin disorders. [1] Any embolus or thrombus in largest feeder vessel known as the artery of Adamkiewicz, can lead to an anterior spinal syndrome. This is the most feared, though rare complication of bronchial artery embolization done in massive hemoptysis. [6]

Anatomy

The anterior portion of the spinal cord is supplied by the anterior spinal artery. It begins at the foramen magnum where branches of the two vertebral arteries exit, merge, and descend along the anterior spinal cord. As the anterior spinal artery proceeds inferiorly, it receives branches originating mostly from the aorta. [1] The largest aortic branch is the artery of Adamkiewicz.[ citation needed ]

Diagnosis

An MRI is used in the process of making a diagnosis for this condition[ citation needed ]

Treatment

Treatment is determined based on the primary cause of anterior cord syndrome. When the diagnosis of anterior cord syndrome is determined, the prognosis is unfortunate. The mortality rate is approximately 20%, with 50% of individuals living with anterior cord syndrome having very little or no changes in symptoms. [1]

Eponym

It is also known as "Beck's syndrome". [7] [8]

See also

Related Research Articles

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Spinothalamic tract Sensory pathway from the skin to the thalamus

The spinothalamic tract is a sensory pathway to the thalamus. From the ventral posterolateral nucleus in the thalamus, sensory information is relayed upward to the somatosensory cortex of the postcentral gyrus.

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Medial medullary syndrome, also known as inferior alternating syndrome, hypoglossal alternating hemiplegia, lower alternating hemiplegia, or Dejerine syndrome, is a type of alternating hemiplegia characterized by a set of clinical features resulting from occlusion of the anterior spinal artery. This results in the infarction of medial part of the medulla oblongata.

Artery of Adamkiewicz

In human anatomy, the artery of Adamkiewicz is the largest anterior segmental medullary artery. It typically arises from a left posterior intercostal artery at the level of the 9th to 12th intercostal artery, which branches from the aorta, and supplies the lower two-thirds of the spinal cord via the anterior spinal artery.

Spinal cord injury Injury to the main nerve bundle in the back of humans

A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury. Injury can occur at any level of the spinal cord and can be complete, with a total loss of sensation and muscle function at lower sacral segments, or incomplete, meaning some nervous signals are able to travel past the injured area of the cord up to the Sacral S4-5 spinal cord segments. Depending on the location and severity of damage, the symptoms vary, from numbness to paralysis, including bowel or bladder incontinence. Long term outcomes also range widely, from full recovery to permanent tetraplegia or paraplegia. Complications can include muscle atrophy, loss of voluntary motor control, spasticity, pressure sores, infections, and breathing problems.

Aortoiliac occlusive disease Medical condition

In medicine, aortoiliac occlusive disease, is a form of central artery disease involving the blockage of the abdominal aorta as it transitions into the common iliac arteries.

Anterior spinal artery

In human anatomy, the anterior spinal artery is the artery that supplies the anterior portion of the spinal cord. It arises from branches of the vertebral arteries and courses along the anterior aspect of the spinal cord. It is reinforced by several contributory arteries, especially the artery of Adamkiewicz.

Conus medullaris

The conus medullaris or conus terminalis is the tapered, lower end of the spinal cord. It occurs near lumbar vertebral levels 1 (L1) and 2 (L2), occasionally lower. The upper end of the conus medullaris is usually not well defined, however, its corresponding spinal cord segments are usually S1-S5.

Affective sensation is an occurrence of sensation accompanied with a strong compulsion to act on it. It refers, mostly in neuroscience, to the emotional sensibility in response to affective stimuli of a particular valence. It is transmitted via the spinothalamic tract through the spinal cord, and can be associated with reflex actions such as the scratch, gag, and withdrawal reflexes. Sensory processing in the brain interacts with behavioral choices, such as decisions to eat or to stop eating, in both healthy individuals and those with eating disorders.

Dissociated sensory loss is a pattern of neurological damage caused by a lesion to a single tract in the spinal cord which involves preservation of fine touch and proprioception withselective loss of pain and temperature

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Anterior white commissure

The anterior white commissure is a bundle of nerve fibers which cross the midline of the spinal cord just anterior to the gray commissure. A delta fibers and C fibers carrying pain sensation in the spinothalamic tract contribute to this commissure, as do fibers of the anterior corticospinal tract, which carry motor signals from the primary motor cortex.

Benedikt syndrome, also called Benedikt's syndrome or paramedian midbrain syndrome, is a rare type of posterior circulation stroke of the brain, with a range of neurological symptoms affecting the midbrain, cerebellum and other related structures.

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Vascular myelopathy refers to an abnormality of the spinal cord in regard to its blood supply. The blood supply is complicated and supplied by two major vessel groups: the posterior spinal arteries and the anterior spinal arteries—of which the Artery of Adamkiewicz is the largest. Both the posterior and anterior spinal arteries run the entire length of the spinal cord and receive anastomotic (conjoined) vessels in many places. The anterior spinal artery has a less efficient supply of blood and is therefore more susceptible to vascular disease. Whilst atherosclerosis of spinal arteries is rare, necrosis in the anterior artery can be caused by disease in vessels originating from the segmental arteries such as atheroma or aortic dissection.

Spinal cord Long, tubular central nervous system structure in the vertebral column

The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column. It encloses the central canal of the spinal cord, which contains cerebrospinal fluid. The brain and spinal cord together make up the central nervous system (CNS). In humans, the spinal cord begins at the occipital bone, passing through the foramen magnum and entering the spinal canal at the beginning of the cervical vertebrae. The spinal cord extends down to between the first and second lumbar vertebrae, where it ends. The enclosing bony vertebral column protects the relatively shorter spinal cord. It is around 45 cm (18 in) in men and around 43 cm (17 in) long in women. The diameter of the spinal cord ranges from 13 mm in the cervical and lumbar regions to 6.4 mm in the thoracic area.

Raymond–Céstan syndrome Medical condition

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Bronchial artery embolization is a treatment for hemoptysis, abbreviated as BAE. It is a kind of catheter intervention to control hemoptysis by embolizing the bronchial artery, which is a bleeding source. Embolic agents are particulate embolic material such as gelatin sponge or polyvinyl alcohol (PVA), and liquid embolic material such as NBCA, or metallic coils.

References

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  2. 1 2 Foo, D; Rossier, AB (Feb 1983). "Anterior spinal artery syndrome and its natural history". Paraplegia. 21 (1): 1–10. doi: 10.1038/sc.1983.1 . PMID   6835686.
  3. Wheele's Orthopedics
  4. Cheshire, WP; Santos, CC; Massey, EW; Howard JF, Jr (Aug 1996). "Spinal cord infarction: etiology and outcome". Neurology. 47 (2): 321–30. doi:10.1212/wnl.47.2.321. PMID   8757000.
  5. Cheung, AT; Weiss, SJ; McGarvey, ML; Stecker, MM; Hogan, MS; Escherich, A; Bavaria, JE (Aug 2002). "Interventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction". The Annals of Thoracic Surgery. 74 (2): 413–9, discussion 420–1. doi:10.1016/s0003-4975(02)03714-1. PMID   12173822.
  6. Yoon, Woong; Kim, Jae Kyu; Kim, Yun Hyun; Chung, Tae Woong; Kang, Heoung Keun (2002). "Bronchial and Nonbronchial Systemic Artery Embolization for Life-threatening Hemoptysis: A Comprehensive Review". Radiographics. 22 (6): 1395–1409. doi:10.1148/rg.226015180. PMID   12432111.
  7. synd/755 at Who Named It?
  8. Beck, Karl (1951–1952). "Das Syndrom des Verschlusses der vorderen Spinalarterie". Deutsche Zeitschrift für Nervenheilkunde. 167 (3): 164–186. doi:10.1007/BF00242756.
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