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Spinal Cord Infarction
Introduction
The diagnosis of spinal cord infarction (SCI) has changed significantly in the past decade, largely due to the contributions of neuroimaging. Historically SCI was considered to be rare, with the definitive diagnosis requiring postmortem examination and probable diagnosis requiring the appropriate clinical context (usually aortic dissection or surgery) and exclusion of other possibilities. With the advent of spinal cord diffusion-weighted imaging (DWI), however, improved diagnosis has resulted in the expansion of research into the underlying etiologies, natural history, and prognosis. SCI is now defined by the American Heart Association as “spinal cord cell death attributable to ischemia, based on pathological, imaging, or other objective evidence of spinal cord focal ischemic injury in a defined vascular distribution.” Although aortic surgery and dissection are still considered important risk factors, SCI is now known to result from numerous entities, including atherosclerosis and embolism, systemic hypotension, vascular malformations, coagulopathies, cocaine, sickle cell disease, diving, and idiopathic causes. The evolving diagnosis of SCI is explored here, with a review of the spinal cord vascular anatomy, clinical findings, imaging, natural history, and diagnostic mimics.
Evolution: Overview
The current understanding of SCI is based on knowledge of spinal cord vascular anatomy, which directly affects the clinical presentation.
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