Spinal Stroke: An atypical cause of back pain

This post was authored by Theresa Neumann and posted to The Eye Opener on April 11th, 2011.

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When one hears the word stroke, what typically comes to mind is a “brain attack” with slurred speech or numbness and weakness of the right or left side of the body. Well, the spinal cord is considered part of the central nervous system and is truly a direct connection to the brain. All of the data received through nerve endings in our bodies passes through the spinal cord to be interpreted in the brain. Likewise, the messages our brain is sending to our bodies, both consciously and unconsciously (e.g. walk, run, write, speak; and digest food, breath, increase heart rate, etc.), travel through the spinal cord to our peripheral nerves.

The spinal cord is a vital structure that has its own blood supply, much like other organs, including the heart and brain. Just like the blood vessels supplying the other organs, the spinal arteries, especially the anterior spinal artery, can become occluded (i.e. blocked) resulting in spinal cord ischemia or infarction. The nerve information can no longer travel to and from the brain or the body freely; it is interrupted. This equates to a “stroke” of the spinal cord with resultant numbness, weakness, paralysis, as well as bowel and bladder dysfunction below the level of the infarction/stroke.

What causes a “spinal stroke”?

The most common cause of spinal stroke is the same as that for brain stroke or heart attack……atherosclerosis, an accumulation of cholesterol plaque in the arterial wall that ultimately blocks the artery. No blood flow means no oxygen or nutrients to the cells and tissues of the spinal cord resulting in them “starving to death.” There are other causes, as well; anything that compresses one of the supply arteries can block blood flow to a region of the cord and result in “stroke.”

Tumors, either primary or metastatic, can compresses blood vessels and other structures as they grow in the spinal region. Anterior disc herniations and disc ruptures or bone fragments from traumatic fractures of the vertebrae can compress blood vessels in the immediate vicinity.

Collections of pus from infectious processes can interrupt the blood supply either by compressing a vessel or disintegrating the blood vessel. ¬†Small pieces of blood clots (called emboli) can break-off from larger clots (called thrombi) and circulate through the bloodstream until they get “stuck” in a smaller vessel somewhere else in the body; the spinal artery is just one location. Other systemic diseases can result in vasculitis, or an inflammation of the blood vessel, that leads to clotting and occlusion of that vessel, and the spinal artery is just one of the vessels that can be affected.

Surgery and spinal stroke

Interestingly, inter-abdominal and spinal surgical procedures can also lead to spinal cord ischemia and stroke. Individuals undergoing repair of an aortic aneurysm or iliac-to-femoral artery bypass often require “cross-clamping” of the aorta above the level of the surgery. The “golden hour” referred to in heart attack victims can also be applied to other vascular ischemic conditions, like spinal artery ischemia; if complications arise and the cross-clamp time is too long, it can result in ischemia from which the patient may never recover, remaining paralyzed for life. Similarly, an aortic dissection can disrupt blood flow to the smaller arteries branching from the aorta to feed the spinal cord leading to ischemia.

Spinal surgeries take one of two approaches, anterior (going through the belly) or posterior (going through the back). Because of the proximity of all of the vital structures, including the major blood vessels, small errors or retained fragments can lead to occlusion or disruption of the spinal blood supply.

Who is at risk for spinal stroke?

Those individuals with risk factors for heart disease or brain stroke are also at risk for spinal stroke since they share a common etiology. This includes those individuals with poorly-controlled diabetes, high cholesterol or dyslipidemia, abnormal clotting of the blood, peripheral arterial disease or history of aneurysms.

What are the symptoms of a spinal stroke?

Most patients present with sudden, severe pain, much like a heart attack, in either the chest or the back or both. This pain is typically rapidly followed by numbness, or loss of pain sensation and temperature sensation, in the extremities below the level of the stroke. Because of the anatomy of the blood supply, vibration sensation and position sense are maintained in the affected region since the posterior region of the cord has a different blood supply. As the spinal stroke progresses over an hour or so, the extremities affected become weaker and weaker, often experiencing paralysis, and the bowel and bladder lose their innervation leading to dysfunction and incontinence. This is a fairly rapid progression, much different that other myelopathies.

What is the treatment?

Due to the relative rarity of this condition, not many studies have been done regarding treatments. Unlike “heart attack” or “brain attack,” there are no standards of care except for aspirin therapy and (potentially) anti-platelet therapy after the stroke has occurred. More often than not, there is a delay in diagnosing the condition due to the rarity of the condition and the need to confirm the diagnosis by a diffusion-weighted enhanced MRI of the spine, such that “clot-busting” agents are time-excluded from use. Treatments are then focused on preventing additional vascular events, preventing deep vein thromboses in the paralyzed limbs, preventing bladder infections and fecal impactions, preventing decubitus ulcers and soft tissue infections, and preventing the additional morbidity associated with paralysis. This is not a comforting thought!

We are blessed with today’s medical technological advances that allow for so many life-saving procedures and procedures that preserve body function, such as spinal surgery, vascular stenting procedures and epidural injections. Unfortunately, some of these procedures have increased the incidence of spinal strokes due to the nature of the procedures themselves. The current epidemic of obesity and metabolic syndrome is also indicative of more cases of diabetes and atherosclerotic vascular disease which, according to the law of probability, will increase the incidence of this potentially devastating medical condition.

Clinical Trials Underway

Do you know someone who has had a spinal stroke? What was his or her age? What might have precipitated the “attack”? Some individuals have been in their early 20′s when the attack occurred. Needless to say, this is truly devastating! With all of our advanced technology, we should be doing a better job of preventing, diagnosing and treating this condition. The National Institutes of Health (NIH) does offer clinical trials for this condition; please refer to their website for further information. (¬†http://www.ninds.nih.gov/disorders/spinal_infarction/spinal_infarction.htm)

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11 Responses to “Spinal Stroke: An atypical cause of back pain”

  1. NicoleNo Gravatar says:

    A person I know had it. He’s only 17, and the only person in Canada to have it under the age 0f 80.

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  3. DeniseNo Gravatar says:

    My mom had a spinal stroke in 2010, during surgery to undergo repair of an aortic aneurysm. She was 71 at the time. This has resulted in a flaccid bowel, in addition to having a stoma for urine. She is wondering if she should have a colostomy due to major bowel issues. It’s hard to find qualified professionals as she lives in a smaller town (90,000 people). What kind of professional would be best to speak to regarding this issue?

  4. Hi, Denise. You should look for a good colorectal surgeon to discuss this matter; it is an option. Even small-town hospitals should have one since the incidence of colon cancer is so high. Do your homework, though, and check out the credentials. It may mean that you need to take her to a neighboring city/town to get the best care, but it would be worth it to have piece of mind knowing that she is in well-trained and experienced hands.

    Theresa

  5. brittanyNo Gravatar says:

    what are the chances of a young girl walking again after she has had a spinal stroke due to a car accident? she still has feeling and it did not affect her bowels in any way. she responds to cold and reacts quickly but we have not been given any other information.

  6. It sounds promising, Brittany, but a lot depends on the location of the spinal stroke. Was it truly a stroke or was it a spinal concussion? If it truly was a stroke, did it affect the dorsal horn or ventral horn of the spinal cord; sensory and motor tracts are different. These are good questions to ask the neurosurgeon. Either way, there are lots of advances in technology for victims of spinal cord injuries. She will need very aggressive rehab if her overall condition allows it!

    Theresa

  7. My 63-year-old friend just had surgery to adjust a stimulator (the paddles) that had been surgically installed in his back several months ago. When he became paralyzed, the doctor took the stimulator out. They said there was swelling around a nerve. Now doctor says that a nerve had a stroke. He’s paralyzed from his mid-chest down.

  8. vasculitisNo Gravatar says:

    John, I totally agree with you. I admit I had my own prejudice regarding soldiers, and was pleasantly surprised to get in touch with Lee. His side of the story made me change my “mass-media influenced opinion”, and reminded me that stereotyping people is bad for your soul. I am extremely happy that Lee wrote this article for One Day for Human Rights, and that you find it useful. :)

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  10. LiliNo Gravatar says:

    Own of my best friends and I lost touch after he gave me away at my wedding. 22 years later when we are talking, courtesy of Social Networking he explains that he isn’t the same person I knew. He goes on to tell me that he had a spinal stroke. He woke up in the morning paralyzed, he can walk (uses a cane now) and drive. However, he has had 2 “attacks” just since we have been talking in the last 2 weeks. Apparently he loses some left side function, I believe he sleeps most of the time, it is painful and yesterday I knew one was coming. He has trouble sleeping normally, not over the last 2 days. He was falling asleep right after sending me a text, I would answer immediately and this time he did not respond for over 10 hours. Since I am sitting here worrying because he planned on contacting me when he was done with family, I am pretty sure he has had another. He only says “attacks” but sounds more like a form of a mini stroke to me. Is this common with those who have had a spinal stroke. He is very stubborn but I know I can make him get to a specialist, but just saw his doctor Monday after one on Saturday. The doctor gave him Oxy. This struck me as odd. Do you have any information about spinal stroke suffers having repeated “attacks” that would cause loss of function and pain? Or is he really having repeated mini spinal strokes? Is there anything they can do to prevent these. It breaks my heart to see him suffering and I want to help him in anyway possible. I appreciate anyone’s help on this one and PLEASE, the faster the better.
    Lili

  11. Dear Lili,
    As I cannot offer medical advice over the internet (or phone for that matter), spinal strokes are extremely rare. If these are repeated events, my question is whether your friend is on blood thinners to prevent the blood from clotting. What is the source of the stroke (or strokes?)? If they are due to blood clots that embolize, where is the source? What is being done to prevent the blood from clotting? Has your friend’s blood been tested for a hypercoagulability condition (extra sticky blood)? Or, is there something else that is preventing blood flow to the spinal cord, like a mass compressing the major arteries? All of these are questions to ask…..ones that need answers from your friend’s physician(s).
    It sounds like an awful situation, and no, it is not usual!

    Theresa Neumann

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