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Spinal Cord Infarction Medication

  • Author: Thomas F Scott, MD; Chief Editor: Helmi L Lutsep, MD  more...
 
Updated: Aug 11, 2015
 

Medication Summary

In general, the prophylaxis of stroke by inhibition of platelet aggregation is prudent and recommended. If an unusual cause for the spinal thrombosis is suggested, such as vasculitis or infection, one must consider drugs effective in that disorder including steroids and antibiotics, respectively.

Inhibition of platelet aggregation should be implemented with the goals of limiting extension of the acute ischemic lesion and reducing the longer-range risks of recurrent stroke, myocardial infarction, and death.

To this point, there have been no reports of the use of thrombolytic agents such as tissue thromboplastin activator in spinal cord infarction.

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Antiplatelet agents

Class Summary

These agents inhibit platelet function by blocking cyclooxygenase and subsequent aggregation. Antiplatelet therapy has been shown to reduce mortality rate by reducing the risk of fatal strokes, fatal myocardial infarctions, and vascular death in patients with a history of transient ischemic attacks.

Aspirin (Anacin, Ascriptin, Bayer Aspirin)

 

Inhibits prostaglandin synthesis, preventing formation of platelet-aggregating thromboxane A2. May be used in low dose to inhibit platelet aggregation and improve complications of venous stases and thrombosis.

Clopidogrel (Plavix)

 

Selectively inhibits ADP binding to platelet receptor and subsequent ADP-mediated activation of glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation.

Aspirin with dipyridamole SR (Aggrenox)

 

Drug combination with antithrombotic action. Aspirin inhibits prostaglandin synthesis, preventing formation of platelet-aggregating thromboxane A2. May be used in low dose to inhibit platelet aggregation and improve complications of venous stases and thrombosis.

Dipyridamole is platelet-adhesion inhibitor that possibly inhibits RBC uptake of adenosine, itself an inhibitor of platelet reactivity. In addition, may inhibit phosphodiesterase activity, leading to increased cyclic-3', 5'-AMP within platelets and formation of potent platelet activator thromboxane A2.

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Contributor Information and Disclosures
Author

Thomas F Scott, MD Professor, Program Director, Department of Neurology, Drexel University College of Medicine; Director, Allegheny MS Treatment Center

Thomas F Scott, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society Advisory Board, Allegheny Chapter

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Howard S Kirshner, MD Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Neurological Association, American Society of Neurorehabilitation, American Academy of Neurology, American Heart Association, American Medical Association, National Stroke Association, Phi Beta Kappa, Tennessee Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.

Additional Contributors

Norman C Reynolds, Jr, MD Neurologist, Veterans Affairs Medical Center of Milwaukee; Clinical Professor, Medical College of Wisconsin

Norman C Reynolds, Jr, MD is a member of the following medical societies: American Academy of Neurology, Association of Military Surgeons of the US, International Parkinson and Movement Disorder Society, Sigma Xi, Society for Neuroscience

Disclosure: Nothing to disclose.

References
  1. Cheshire WP, Santos CC, Massey EW, Howard JF Jr. Spinal cord infarction: etiology and outcome. Neurology. 1996 Aug. 47(2):321-30. [Medline].

  2. Salvador de la Barrera S, Barca-Buyo A, Montoto-Marques A. Spinal cord infarction: prognosis and recovery in a series of 36 patients. Spinal Cord. 2001 Oct. 39(10):520-5. [Medline].

  3. Combarros O, Vadillo A, Gutierrez-Perez R. Cervical spinal cord infarction simulating myocardial infarction. Eur Neurol. 2002. 47(3):185-6. [Medline].

  4. Weber P, Vogel T, Bitterling H, Utzschneider S, von Schulze Pellengahr C, Birkenmaier C. Spinal cord infarction after operative stabilisation of the thoracic spine in a patient with tuberculous spondylodiscitis and sickle cell trait. Spine. 2009 Apr 15. 34(8):E294-7. [Medline].

  5. Joseph G, Santosh C, Marimuthu R. Spinal cord infarction due to a self-inflicted needle stick injury. Spinal Cord. 2004 Nov. 42(11):655-8. [Medline].

  6. Hogan EL, Romanul FC. Spinal cord infarction occurring during insertion of aortic graft. Neurology. 1966 Jan. 16(1):67-74. [Medline].

  7. Ross RT. Spinal cord infarction in disease and surgery of the aorta. Can J Neurol Sci. 1985 Nov. 12(4):289-95. [Medline].

  8. Faivre A, Bonnel S, Leyral G, Gisserot O, Alla P, Valance J. [Essential thrombocythemia presenting as spinal cord infarction.]. Presse Med. 2009 Apr 22. [Medline].

  9. Lyders EM, Morris PP. A Case of Spinal Cord Infarction Following Lumbar Transforaminal Epidural Steroid Injection: MR Imaging and Angiographic Findings. AJNR Am J Neuroradiol. 2009 Apr 15. [Medline].

  10. Zhang J, Huan Y, Qian Y. Multishot diffusion-weighted imaging features in spinal cord infarction. J Spinal Disord Tech. 2005 Jun. 18(3):277-82. [Medline].

  11. Vijayan N, Peacock JH. Spinal cord infarction during use of zolmitriptan: a case report. Headache. 2000 Jan. 40(1):57-60. [Medline].

  12. Sandson TA, Friedman JH. Spinal cord infarction. Report of 8 cases and review of the literature. Medicine (Baltimore). 1989 Sep. 68(5):282-92. [Medline].

  13. Satran R. Spinal cord infarction. Stroke. 1988 Apr. 19(4):529-32. [Medline].

  14. Lee SH, Kim SB, Choi SG, Lim YJ. Paraplegia due to Spinal Cord Infarction After Lifting Heavy Objects. J Korean Neurosurg Soc. 2008 Feb. 43(2):114-6. [Medline]. [Full Text].

  15. Tosi L, Rigoli G, Beltramello A. Fibrocartilaginous embolism of the spinal cord: a clinical and pathogenetic reconsideration. J Neurol Neurosurg Psychiatry. 1996 Jan. 60(1):55-60. [Medline]. [Full Text].

  16. Weidauer S, Nichtweiss M, Lanfermann H. Spinal cord infarction: MR imaging and clinical features in 16 cases. Neuroradiology. 2002 Oct. 44(10):851-7. [Medline].

  17. Luo CB, Chang FC, Teng MM. Magnetic resonance imaging as a guide in the diagnosis and follow-up of spinal cord infarction. J Chin Med Assoc. 2003 Feb. 66(2):89-95. [Medline].

  18. Küker W, Weller M, Klose U. Diffusion-weighted MRI of spinal cord infarction--high resolution imaging and time course of diffusion abnormality. J Neurol. 2004 Jul. 251(7):818-24. [Medline].

  19. Shinoyama M, Takahashi T, Shimizu H. Spinal cord infarction demonstrated by diffusion-weighted magnetic resonance imaging. J Clin Neurosci. 2005 May. 12(4):466-8. [Medline].

  20. Thomas T, Branson HM, Verhey LH, Shroff M, Stephens D, Magalhaes S, et al. The Demographic, Clinical, and Magnetic Resonance Imaging (MRI) Featuresof Transverse Myelitis in Children. J Child Neurol. 2012;27:11-21. 1. 27:11-21. [Full Text].

  21. Robertson CE, Brown RD Jr, Wijdicks EF, Rabinstein AA. Recovery after spinal cord infarcts: Long-term outcome in 115 patients. Neurology. 2012 Jan 10. 78(2):114-21. [Medline].

  22. Castro-Moure F, Kupsky W, Goshgarian HG. Pathophysiological classification of human spinal cord ischemia. J Spinal Cord Med. 1997 Jan. 20(1):74-87. [Medline].

  23. Cheng MY, Lyu RK, Chang YJ, Chen CM, Chen ST, Wai YY, et al. Concomitant spinal cord and vertebral body infarction is highly associated with aortic pathology: a clinical and magnetic resonance imaging study. J Neurol. 2009 Apr 28. [Medline].

  24. Cheshire WP Jr. Spinal cord infarction mimicking angina pectoris. Mayo Clin Proc. 2000 Nov. 75(11):1197-9. [Medline].

  25. Cunningham JN. Spinal cord ischemia. Semin Thorac Cardiovasc Surg. 1973. 10:3-5.

  26. Di Chiro G, Herdt JR. Angiographic demonstration of spinal cord arterial occlusion in postradiation myelomalacia. Radiology. 1973 Feb. 106(2):317-9. [Medline].

  27. Garland H, Greenberg J, Harriman DG. Infarction of the spinal cord. Brain. 1966 Dec. 89(4):645-62. [Medline].

  28. Gass A, Back T, Behrens S, Maras A. MRI of spinal cord infarction. Neurology. 2000 Jun 13. 54(11):2195. [Medline].

  29. Hogan EL, Dale AJD. Disorders of the spinal cord. In: Clinical Medicine. Vol 10. 1982:1-36.

  30. Laguna J, Cravioto H. Spinal cord infarction secondary to occlusion of the anterior spinal artery. Arch Neurol. 1973 Feb. 28(2):134-6. [Medline].

  31. Leite I, Monteiro L. Spinal cord infarction. Neurology. 1997 May. 48(5):1478. [Medline].

  32. Wheeler HB, O'Donnell JA, Anderson FA. Bedside screening for venous thrombosis using occlusive impedance phlebography. Angiology. 1975 Feb. 26(2):199-210. [Medline].

  33. Young G, Krohn KA, Packer RJ. Prothrombin G20210A mutation in a child with spinal cord infarction. J Pediatr. 1999 Jun. 134(6):777-9. [Medline].

 
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Transverse section of spinal cord showing location of main pathways. The lamination of fibers in posterior columns and in lateral spinothalamic and lateral corticospinal tracts is indicated (C, cervical; T, thoracic; L, lumbar; S, sacral).
Simplified representation of course of major sensory pathways in the spinal cord. Decussation of the spinothalamic tracts occurs within one or two segments of their entry.
Pattern of arterial supply to spinal cord and (left) territories of the anterior and posterior spinal arteries.
Guide to clinical determination of the segmental spinal cord level.
Transverse section of spinal cord at T12-L1 showing infarction of central cord. The patient became paraplegic following resection of a ruptured abdominal aortic aneurysm. During surgery, prolonged occlusion of the abdominal aorta and great anterior radicular artery was necessary.
 
 
 
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