|
Occlusion of the anterior spinal artery produces a distinctive
syndrome: loss of spinothalamic and corticospinal tract function
with preservation of the dorsal column functions (as the latter is
supplied by the two posterior spinal arteries).
Anterior cord ischemia typically presents the abrupt onset of radicular or
diffuse back pain, flaccid weakness, sphincter dysfunction, and a sensory level
for pain and temperature with preservation of the posterior column sensations of
touch and position sense. The limbs involved and the sensory level depends on
the level at which the ischemia occurs. While the region of the cord most at
risk because of poor collateral circulation is T5-T7, any region of the cord can
become ischemic.
Aortic disease is the most likely etiology for
cord ischemia but cardiac emboli,
coagulopathies, and vasculitides, are also potential causes.
Thus, the patient is paralyzed to a varying degree below the level of the
stroke with complete loss of pain and temperature sensation, but with
preservation of vibration and joint position sense. |
