Oxygen, the lifeline of cells and tissues, is crucial for the body’s metabolism and in the breakdown of complex molecules to generate energy for various functions. Oxygen courses through the body with blood. Tissues or organs, when deprived of oxygen, face necrosis or cell death. This is also called infarction.
“We are all familiar with the term heart attack, which is myocardial infarction, or stroke, which is brain infarction. Similarly, the cessation of the blood supply to the spinal cord leads to spinal cord infarction [or spinal cord stroke],” says Dr Priyank Vasavada, consultant neurosurgeon, Shree Giriraj Hospital, Rajkot, Gujarat.
The factors that cause a spinal cord stroke are similar to those of a heart attack or brain stroke: high cholesterol, blood pressure and diabetes. However, spinal cord infarctions are relatively rare and account for less than 5 per cent of stroke incidents, he adds.
Common symptoms
An infarction of the spinal cord – from where nerve supply to various body parts originates – damages tissues and impairs nerve functions. Its symptoms depend on the area of the cord where the damage has occurred. Dr Vasavada explains that spinal infarction leads to:
- Motor disturbances involving either upper or lower limbs or both
- Weakness in the affected area
- Acute back pain
- Sensory disturbances like reduced sensation of touch, pain or vibration sensation.
- Tingling or burning sensation in the affected part
- Constipation
- Urinary incontinence
- Sexual dysfunction
The symptoms can be debilitating, hampering the affected person’s day-to-day work and quality of life.
What cuts oxygen supply?
Oxygen supply to the spinal cord tissue can get disrupted for various reasons, says Dr Vasavada. Among them, he says, “The arteries supplying blood [to the spinal cord] either [become] narrow or get blocked due to blood clots, dyslipidaemia [high cholesterol], high blood pressure or atherosclerosis. Another common cause is traumatic injury, which causes injury to the blood vessels supplying the spinal cord and can lead to infarction,” he explains.
As a result, the nerves get damaged as the tissues shift to anaerobic respiration, where, without oxygen, they can still sustain for some time. But after a while, because of the continuous lack of oxygen in the tissue, certain enzymes inside the cells called proteolytic enzymes leak from the cells into the surrounding environment. These enzymes can completely dissolve the cells, causing necrosis or cell death.
Eventually, infarction damages neurons in the affected area, causing the symptoms.
Diagnosing spinal cord stroke
Dr Vasavada says that spinal cord infarctions are detected by the sudden onset of the symptoms. In the case of a slipped disc, a degenerative spine disease or a spinal cord tumour, the symptoms may progress gradually, but not so in the case of spinal infarctions. These symptoms are acute.
Hence, a typical diagnosis begins with a clinical history about how long the symptoms were present and whether they have acute or chronic onset, says Dr Vasavada.
Magnetic resonance imaging (MRI) usually confirms an infarct and also locates at what level it is present in the spinal cord.
“Finally, angiography is done to know which [blood] vessel is affected, how much it is damaged or if any large vessel is involved,” says Dr Vasavada.
Managing the condition
Timely management of a spinal cord infarction is crucial to reduce the extent of infarction and its associated effects. “If the person has arrived in the acute phase, blood thinners are administered to reverse the effect of infarction. However, the time window for this intervention is very narrow – less than 4.5 hours. Beyond that, it is impossible to salvage the dead tissue,” says Dr Vasavada.
Blood thinners and antiplatelet agents form a long-term treatment to reduce or prevent any future infarction.
Surgical intervention can be done when blood vessels compress due to traumatic injuries or tumours.
Since the nerves are affected, a person with spinal cord infarctions requires physiotherapy, exercise and rehabilitation, all of which help restore the lost bodily functions as much as possible, Dr Vasavada says.
