Medical Care
The standard drug therapy is aspirin. This is based upon the consensus recommendation for acute treatment of ischemic stroke at any site. Clopidogrel and a combination of aspirin and controlled-release dipyridamole also may be of benefit in reducing the risk of myocardial infarction, recurrent stroke, and death. No direct studies have examined efficacy of drug therapy in spinal cord infarction. This is because of the uncommon nature of the disorder and frequent delay in diagnosis. However, a multicenter study of these therapies would be possible and may yet be done.
The standard measures for management of the complications of acute paraplegia, directed at prevention of peripheral thrombophlebitis and pulmonary embolism, are recommended. These include pulsatile leg wraps, low-dose heparin administered subcutaneously, and physiotherapy.
Neuroprotective strategies, including antioxidant, antiglutamatergic, and protease inhibition, improve outcome in animal experimentation with models of acute ischemia but have not yet been reported effective in human cord ischemia. One would hope that these approaches are more vigorously pursued as research into modes of preventing cell death progresses.
Anticoagulation is considered at 2 dosage levels with different rationales (see above). It is considered at low dosage with the goals of preventing peripheral venous thrombosis and reducing the risk of pulmonary embolism, and it is considered at higher dosage with the goals of preventing extension of the acute ischemic injury and, over the longer term, of reducing recurrent morbidity and mortality rates. However, as stated previously, no definitive studies define the use of anticoagulation in spinal cord infarction.
Consultations
If compressive lesions are observed, consultation with a neurosurgeon may be warranted. Physiatry or neurorehabilitation specialists may be consulted to implement rehabilitiation measures, including prevention of decubiti and spasticity.
Diet
Diet is not directly relevant. A diet with a high fiber content prevents constipation.
Activity
Early in the course, transfer to chair and ambulation as possible adjuncts to rehabilitation and to prevent thrombophlebitis and pulmonary embolization.
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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).
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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.
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Pattern of arterial supply to spinal cord and (left) territories of the anterior and posterior spinal arteries.
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Guide to clinical determination of the segmental spinal cord level.
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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.
