Pdf thrombolysis in anterior spinal artery syndrome. The diagnosis usually is made on the basis of clinical findings because the cause of the syndrome remains obscure in most cases 2. Common etiologies include mediastinal surgeries 1 2, diabetes with atherosclerosis 3, diseases of the aorta 4, hematological. Anterior spinal artery syndrome with chronic traumatic. The anterior spinal artery of adamkiewicz which supplies this region of the spinal cord is susceptible to occlusion in the midlumbar region as the radicular artery supplying it is an end artery. The anterior spinal artery asa commonly originates from a unilateral ramus just distal to the pica. A true acs results from a vascular lesion at the anterior spinal artery asa resulting in ischemic injury to the respective area of.
Anterior spinal artery syndrome in a girl with down syndrome. The symptoms resolved at first, but then recurred 3 years later and progressed slowly. Anterior spinal artery syndrome and its natural history. It is characterized by a corresponding loss of motor function. Bilateral angioplasty of the vertebral arteries was performed successfully and post. Disruption of the anterior spinal artery leads to bilateral disruption of the corticospinal tract, causing motor deficits, and bilateral disruption of the spinothalamic tract, causing sensory deficits in the form of paintemperature sense loss. The cause of this syndrome is destruction of certain portions of the spinal cord by a sudden occlusion of the anterior spinal artery or its branches. A 65yearold patient with ischemic heart disease and hypertensive nephropathy had paraplegia develop after elective coronary artery revascularization caused by anterior spinal infarction. Anterior spinal artery aneurysm presenting as a subarachnoid hemorrhage. Posterior spinal artery an overview sciencedirect topics. Anterior spinal artery syndrome complicated by the ondine. Diagnostic tests for anterior spinal artery syndrome.
An otherwise healthy 40yearold man presented with acute rightsided body weakness. Nov 21, 2015 anterior spinal artery syndrome crash. The anterior spinal artery syndrome was first described by spiller 1 in a case of thrombosis of this artery. Find out information about anterior spinal artery syndrome. The anterior spinal artery syndrome occurs as a result of the occlusion of the anterior spinal artery itself or of the arteries that reinforce it see chapter 3. Anterior spinal artery definition of anterior spinal artery. Anterior spinal artery syndrome after peripheral angiography.
However, there are a few reports of ie occurring in the setting of immunosuppression secondary to cancer andor chemotherapy. The anterior spinal artery supplies the anterior portion of the spinal cord and arises from the vertebral artery in the region of the medulla oblongata. A case of anterior spinal artery syndrome caused by. The anterior spinal artery syndrome in three patients is described and from the literature 6o additional patients were collected. Anterior spinal artery syndrome the most common clinical presentation of a spinal cord infarction is anterior spinal artery asa syndrome. We present a case of anterior spinal artery syndrome in a 57yearold man having a total hip arthroplasty under epidural anaesthesia. We report a case of anterior spinal artery syndrome in which the patient had severe stenosis of a vertebral artery, occlusion of. Anterior spinal artery an overview sciencedirect topics. The risk of rebleeding from ruptured intracranial aneurysms. The two vertebral arteries one of which is usually bigger than the other anastamose in the midline to form a single anterior spinal artery at the level of the foramen magnum. Occurs due to aortic dissection, atherosclerosis of aorta, sle, aids, av malformation rarely due to dissection of the anterior spinal artery or systemic arteritis. When the cervical spine is involved, breathing disorders may be observed. Dec 30, 2011 an angiogram demonstrated bilateral vertebral artery vasospasm with no filling of the anterior spinal artery. Anterior spinal artery syndrome is the most common form of spinal cord infarction.
Infectious endocarditis ie typically occurs in the setting of intravenous drug use, prosthetic heart valves, or rheumatic heart disease. There was no change in neurological status 24 hours later. The diagnosis of anterior spinal artery syndrome can be made with high accuracy by thorough clinical examination in combination with typical magnetic resonance imaging findings. Anterior spinal artery syndrome article about anterior. Motor recovery in the following groups of patients was noted. Spinal cord infarction sci is rarely caused by vertebral artery dissection vad, which is an important cause of posterior circulation stroke in young and middleaged patients. The common causes of anterior cord syndrome are aortic dissection and aortic surgical interventions. Anterior spinal cord syndrome acs is a lesion affecting the anterior twothirds of the spinal cord with loss of motor control below the lesion with intact crude sensation 1, 2. Figure 3 onethird of cases will present with radiating pain which is an important clinical clue for sci. Ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral twothirds of the spinal cord. A true acs results from a vascular lesion at the anterior spinal artery asa resulting in ischemic injury to the respective area of the spinal cord. We report the case of a middleaged patient without obvious risk factors for atherosclerosis who had sci from right vad. The anterior spinal artery supplies the anterior two thirds of the spinal cord, the remaining posterior third.
Anatomy of spinal cord vascularization, aortic branches on the right and spinal cord arteries on the left. This symptom complex is so definite that it permits of an accurate clinical diagnosis, the symptoms varying somewhat with the level of the occlusion. Treatments for anterior spinal artery syndrome including drugs, prescription medications, alternative treatments, surgery, and lifestyle changes. But no case of reversible anterior spinal artery syndrome after balloon kyphoplasty is to be found in the literature as yet. The posterior arteries supply the sensory tracts in the spinal cord and receive flow from posterior and inferior cerebellar arteries, the vertebral arteries, and the posterior radicular arteries. Postoperatively bilateral lower limb motor weakness was attributed to the initial dose of local anaesthetic. Anterior spinal artery syndrome after total spondylectomy of. Anterior spinal artery syndrome after aortic surgery in a. A single anterior spinal artery arises from branches off both vertebral arteries to supply the anterior twothirds of the spinal cord. Anterior spinal artery syndrome commonest of the vascular syndromes of the cord. Spinal complications are rare after coronary artery bypass grafting.
Anterior spinal artery syndrome asas or spillers syndrome is named for william g. This syndrome manifests as a suspended pattern of total anesthesia at the affected level. D7 intercostal artery d7 radicular artery aorta spinal cord c3 radicular artery vertebral artery pial plexus radicular artery anterior spinal artery anterior nerve root anterior sulcus sulcal arteries fig. Asas is thrombosis ventral to the spinal cord causing blockage of the anterior spinal artery asa and an infarction of the areas supplied. There are many causes for an anterior spinal artery syndrome, for example, mikroangiopathia, duralavfistula, vasculitis, or the injuryembolism of the adamkiewicz artery described above. Shortly after severe blunt chest trauma, a young man experienced neurological symptoms suggestive of a spinal cord lesion at the lower thoracic level. This vessel arises from the terminal ends of the vertebral arteries and courses on the midline surface in the median longitudinal fissure of the spinal cord. You will receive an email whenever this article is corrected, updated, or cited in the literature. The typical patient at risk of anterior spinal artery syndrome is an elderly patient with a past history of arteriosclerosis or recent period of hypotension, who presents with a sudden onset of flaccid paralysis.
To report a rare case of spinal cord ischemia following. Anterior spinal artery radiology reference article. A case of anterior spinal cord syndrome in a patient with. This occurs when the disruption of the anterior spinal. Spontaneous unruptured nondissected aortic aneurysms with intramural thrombus can rarely cause anterior cord infarctions. Anterior spinal artery syndrome definition of anterior. This condition is usually associated with atherosclerosis of the aorta and may result from dissection of an aortic aneurysm or rarely dissection of the anterior spinal artery. The onset of signs and symptoms is abrupt, and the functional losses correspond to the territory of distribution that the artery supplies i. The region affected includes the descending corticospinal tract, ascending spinothalamic tract, and autonomic fibers. A case report of temporary anterior spinal artery syndrome secondary to peripheral angiography of the lower limbs.
Anterior spinal artery syndrome or becks syndrome or anterior cord syndrome is a rare neurovascular condition characterized by sudden ischemia with damage to the anterior 23rd of the spinal cord. Anterior spinal artery syndrome is rare in children. An angiogram demonstrated bilateral vertebral artery vasospasm with no filling of the anterior spinal artery. The posterior arteries supply the sensory tracts in the spinal cord and receive flow from posterior and inferior cerebellar arteries, the vertebral arteries, and the posterior radicular. Anterior spinal artery syndrome asas is a very rare condition which occurs following infarction of the anterior twothird of the spinal cord supplied by the anterior spinal artery. We present three patients with a nontraumatic cervical anterior spinal artery syndrome, two of whom developed painful burning dysaesthesias below the level of spinal cord lesion, refractory to opiate, anticonvulsant and tricyclic antidepressant therapy.
Anterior spinal artery syndrome the spinal cord receives blood supply from two posterior arteries 25% and one anterior spinal artery 75%. Information on how to subscribe to neurology and neurology. In adults, where it is observed most frequently after resection of thoracoabdominal aortic aneurysms, spinal magnetic resonance imaging is considered the firstline investigation to confirm the clinical diagnosis. Anterior spinal artery syndrome in a patient with vasospasm. Request pdf anterior spinal artery syndrome after total spondylectomy of t10, t11, and t12 although radical resection is the best treatment for local aggressive benign tumors or malignant. Anterior spinal artery syndrome synonyms, anterior spinal artery syndrome pronunciation, anterior spinal artery syndrome translation, english dictionary definition of anterior spinal artery syndrome. Posterior spinal artery infarctions are less common than anterior infarctions, but they do occur. The anterior spinal artery may be duplicated in some regions which could explain the occurrence of unilateral anterior infarction.
Giant somatosensory evoked potentials in a patient with the. Anterior spinal artery syndrome in an adolescent with protein. The cause of the infarction can be either iatrogenic or secondary to diseases. The anterior spinal cord is at increased risk for infarction because it is supplied by the single anterior spinal artery, which has few collateral unlike the posterior spinal cord which is supplied by two posterior spinal arteries. We report a case of anterior spinal artery syndrome in which immediate and 3year follow. Spiller who described it 1909, however preobranshenski was the first to describe asas in 1904. Anterior spinal artery syndrome following total hip.
The most common causes are arteriosclerosis, dissection of the. Here, we present a case of a cancer patient who developed anterior spinal artery asa syndrome secondary to a. Anterior cord syndrome present with paraparesis or quadriparesis with sparing of vibration and proprioceptive senses. Neurological workup failed to define the cause until a thoracic aortogram showed an aneurysm in the middle portion of the descending aorta in close proximity. Background anterior spinal artery asa syndrome results in motor palsy and dissociated sensory loss below the level of the lesion, accompanied by bladder dysfunction. Anterior spinal artery syndrome asas is often a devastating spinal stroke occurring when the anterior spinal artery or one of its supplying anterior medullary arteries are occluded. This condition is usually associated with atherosclerosis of the aorta and may result from dissection of an aortic aneurysm or rarely. The payee may view, download, andor print the article for. Diagnostic tests for anterior spinal artery syndrome including blood tests, urine tests, swabs, diagnostic tests, lab tests, and pathology testing. Spinal cord infarction because of spontaneous vertebral. You can manage this and all other alerts in my account. Anterior spinal artery syndrome after elective coronary.
Spinal cord anatomy blood supply 3d anatomy tutorial duration. The spinal cord receives blood supply from two posterior arteries 25% and one anterior spinal artery 75%. Anterior spinal artery occlusion syndrome concept id. Fusiform vertebral artery aneurysms involving the posterior. Ultraearly rebleeding of an anterior spinal artery aneurysm. The anterior spinal artery syndrome is the most common presentation of sci as illustrated in our patient. The authors propose a treatment paradigm for asa preservation based on the arterys proximity to fusiform va aneurysms, and they present 3 representative cases. There are many causes for an anterior spinal artery syndrome, for example, mikroangiopathia, duralavfistula, vasculitis, or the injuryembolism of. Occlusion of an unpaired asa can result in bilateral medial medullary syndrome.
Anterior spinal artery syndrome also known as anterior spinal cord syndrome is syndrome caused by ischemia of the anterior spinal artery, resulting in loss of function of the anterior twothirds of the spinal cord. The anterior spinal artery gives unilateral alternating branches sulcal arteries. Anterior spinal artery and its relationship to the artery of adamkiewicz the asa anterior spinal artery provides perfusion to the majority of the anterior region of the spinal cord 1. Quantitative and clinical sensory examination showed dissociated loss of pin. Sudden onset of tetra or paraparesis and dissociated sensory loss with bladder dysfunction are the leading clinical signs. The most common causes are arteriosclerosis, dissection of the abdominal aorta, cardiac embolism and degenerative spine disease, and the major risk factors are smoking, hypertension, diabetes and.
Consistent with its functional neuroanatomy, an asa infarct typically presents as loss of motor function and paintemperature sensation, with relative sparing of proprioception and vibratory sense. Med any combination of signs and symptoms that are indicative of a particular disease or disorder syndrome, mr. Ruptured anterior spinal artery aneurysm from a herniated. Thrombolysis in anterior spinal artery syndrome bmj case.
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