Spinal cord infarction

[Vania]

Spinal cord infarction usually results from ischemia originating in an extravertebral artery. Symptoms include sudden and severe back pain, followed immediately by rapidly progressive bilateral flaccid limb weakness and loss of sensation, particularly for pain and temperature. Diagnosis is by MRI. Treatment is generally supportive.
(See also Overview of Spinal Cord Disorders.)
The primary vascular supply for the posterior third of the spinal cord is the posterior spinal arteries; for the anterior two thirds, it is the anterior spinal artery. The anterior spinal artery has only a few feeder arteries in the upper cervical region and one large feeder (the artery of Adamkiewicz) in the lower thoracic region. The feeder arteries originate in the aorta.
Because collateral circulation for the anterior spinal artery is sparse in places, certain cord segments (eg, those around the 2nd to 4th thoracic segments) are especially vulnerable to ischemia. Injury to an extravertebral feeder artery or the aorta (eg, due to atherosclerosis, dissection, or clamping during surgery) causes infarction more commonly than do intrinsic disorders of spinal arteries. Thrombosis is an uncommon cause, and polyarteritis nodosa is a rare cause.